Treatment system, and treatment method for living tissue using energy

ABSTRACT

A treatment system includes a pair of holding members, a high-frequency energy output section, a heat generating section and a control section. At least one of the pair of holding members moves to the other holding member. The high-frequency energy output section and the heat generating section are provided on at least one of the holding members. The high-frequency energy output section exerts high-frequency energy to a living tissue to denature the living tissue, and collects the biological information of the living tissue. The heat generating section applies heat to it held between the holding members, generates the heat owing to the supply of the energy, and conducts the heat therefrom to denature the living tissue. The control section controls the output of the energy to the high-frequency energy output section and the heat generating section based on the biological information collected by the high-frequency energy output section.

CROSS REFERENCE TO RELATED APPLICATIONS

The present patent application is a continuation of prior U.S. patentapplication Ser. No. 15/472,958, filed Mar. 29, 2017, by TomoyukiTAKASHINO and Kenichi KIMURA and entitled “TREATMENT SYSTEM, ANDTREATMENT METHOD FOR LIVING TISSUE USING ENERGY,” which is acontinuation of U.S. patent application Ser. No. 12/060,359, filed Apr.1, 2008, now U.S. Pat. No. 9,642,669, issued May 9, 2017. The contentsof each of the patent applications listed above are incorporated in fullherein by reference.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The present invention relates to a treatment system for treating aliving tissue by use of energy, and a treatment method for a livingtissue using energy.

2. Description of the Related Art

In US Patent Application Publication No. US2005/0113828 A1, anelectrosurgical instrument is disclosed in which a living tissue is heldbetween a pair of openable/closable jaws, and a high-frequency currentis applied between the pair of jaws holding the living tissuetherebetween to denature the held living tissue. Here, in theelectrosurgical instrument, high-frequency energy flows thorough theliving tissue to immediately denature the inside of the tissue by use ofJoule heat generated in the living tissue. Then, the electrosurgicalinstrument immediately destroys cell membranes to release, from thedestroyed cell membranes, an intracellular fluid including polymercompounds typified by protein, and homogenizes (liquefies) intracellularcomponents with extracellular components typified by collagen. Suchhomogenization can result in the mutual bonding of bonding faces of theliving tissues and the mutual bonding of interlayers of the tissues. Itis to be noted that when the high-frequency energy is applied to theliving tissue, the state (impedance or phase information) of the livingtissue can be detected. In general, there are characteristics that asthe impedance of the held living tissue is high, the output of thehigh-frequency energy which can be applied to the living tissuedecreases.

In Jpn. Pat. Appln. KOKAI Publication No. 2001-190561, a coagulationtreatment instrument is disclosed in which a pair of openable/closablejaws are provided with a ceramic heater. In the ceramic heater, aheating element is embedded, and when a power is supplied through theheating element, the ceramic heater generates heat. Then, the heat ofthe ceramic heater is conducted to the living tissue held between thepair of jaws to coagulate the living tissue. At this time, if the heatis generated at a set temperature from the heating element, the heatenergy can uniformly be applied to the living tissue regardless of thestate of the living tissue. Therefore, the desired output can uniformlybe performed, even in a state in which the high-frequency energy cannotsufficiently be output to the living tissue in the treatment using thehigh-frequency energy, for example, after the impedance of the livingtissue rises.

BRIEF SUMMARY OF THE INVENTION

According to a first aspect of the present invention, there is provideda treatment system which exerts energy to a living tissue to treat theliving tissue, including:

a pair of holding members which hold the living tissue therebetween, atleast one of the holding members being configured to relatively movewith respect to the other holding member and to hold the living tissue;

a high-frequency energy output section which is provided on at least oneof the holding members and which exerts high-frequency energy to theliving tissue to denature the living tissue and which collects thebiological information of the living tissue held between the holdingmembers;

a heat generating section which is provided on at least one of theholding members and which applies heat to the living tissue held betweenthe holding members, the heat generating section being configured togenerate the heat owing to the supply of the energy and to conduct theheat therefrom, thereby denaturing the living tissue; and

a control section which controls the output of the energy to thehigh-frequency energy output section and the heat generating sectionbased on the biological information collected by the high-frequencyenergy output section.

According to a second aspect of the present invention, there is provideda treatment system including:

a treatment instrument including a treatment section having electrodesto which a high-frequency power is to be supplied and a heat generationelement, the treatment section being able to hold a living tissue;

a high-frequency driving circuit which supplies a high-frequency powerto the electrodes to treat the living tissue held by the treatmentsection with high-frequency energy and which collects informationobtained from the living tissue through the electrodes;

a heat generation element driving circuit which supplies a heatgeneration power to the heat generation element to treat the livingtissue held by the treatment section owing to the function of heat andwhich collects temperature information transmitted to the living tissuethrough the heat generation element; and

a control section which controls the high-frequency driving circuit andthe heat generation element driving circuit based on the informationcollected by the high-frequency driving circuit and/or the heatgeneration element driving circuit.

According to a third aspect of the present invention, there is provideda treatment method which exerts energy to a living tissue to treat theliving tissue, including:

holding the living tissue;

applying high-frequency energy to the held living tissue and obtainingthe biological information of the living tissue; and

applying heat to the living tissue based on the biological informationof the living tissue.

According to a fourth aspect of the present invention, there is provideda treatment method which exerts energy to a living tissue to treat theliving tissue, including:

heating the living tissue at a first temperature;

applying high-frequency energy to the living tissue and obtaining thebiological information of the living tissue; and

switching the first temperature to a second temperature which isdifferent from and higher than the first temperature to heat the livingtissue, based on the biological information of the living tissue.

Additional objects and advantages of the invention will be set forth inthe description which follows, and in part will be obvious from thedescription, or may be learned by practice of the invention. The objectsand advantages of the invention may be realized and obtained by means ofthe instrumentalities and combinations particularly pointed outhereinafter.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate embodiments of the invention, andtogether with the general description given above and the detaileddescription of the embodiments given below, serve to explain theprinciples of the invention.

FIG. 1 is a schematic diagram showing a treatment system according to afirst embodiment of the present invention;

FIG. 2 is a schematic block diagram showing the treatment systemaccording to the first embodiment;

FIG. 3A is a schematic diagram showing the treatment system according tothe first embodiment in a case where high-frequency energy is applied toa living tissue to treat the tissue with a bipolar surgical treatmentinstrument;

FIG. 3B is a schematic diagram showing the treatment system according tothe first embodiment in a case where high-frequency energy is applied tothe living tissue to treat the tissue with a monopolar surgicaltreatment instrument;

FIG. 4 is a schematic flow chart showing a case where a treatment usingthe high-frequency energy and a treatment using heat energy areperformed with respect to the living tissue by use of the treatmentsystem according to the first embodiment;

FIG. 5 is a schematic graph showing a relation between impedance andtime in a case where the treatment using the high-frequency energy andthe treatment using the heat energy are performed with respect to theliving tissue by use of the treatment system according to the firstembodiment;

FIG. 5A is a schematic block diagram showing a treatment systemaccording to a first modification of the first embodiment;

FIG. 5B is a schematic graph showing a relation between phase and timeobtained from output voltage value information, output voltage phaseinformation, output current value information and output current phaseinformation in a case where a treatment using high-frequency energy anda treatment using heat energy are performed with respect to a livingtissue by use of the treatment system according to the firstmodification of the first embodiment;

FIG. 6 is a schematic flow chart in a case where a treatment usinghigh-frequency energy and a treatment using heat energy are performedwith respect to a living tissue by use of a treatment system accordingto a second modification of the first embodiment;

FIG. 7 is a schematic flow chart in a case where a treatment usinghigh-frequency energy and a treatment using heat energy are performedwith respect to a living tissue by use of a treatment system accordingto a third modification of the first embodiment;

FIG. 8 is a schematic block diagram showing a treatment system accordingto a fourth modification of the first embodiment;

FIG. 9 is a schematic diagram showing a treatment system according to asecond embodiment of the present invention;

FIG. 10A is a schematic vertical sectional view showing a shaft of anenergy treatment instrument and a state where a first holding member anda second holding member of a holding section are closed in the treatmentsystem according to the second embodiment;

FIG. 10B is a schematic vertical sectional view showing the shaft of theenergy treatment instrument and a state where a first holding member anda second holding member of a holding section are opened in the treatmentsystem according to the second embodiment;

FIG. 11A is a schematic plan view showing the first holding member on aside close to the second holding member in the holding section of theenergy treatment instrument of the treatment system according to thesecond embodiment;

FIG. 11B is a schematic vertical sectional view showing the firstholding member cut along the 11B-11B line of FIG. 11A in the holdingsection of the energy treatment instrument of the treatment systemaccording to the second embodiment;

FIG. 11C is a schematic transverse sectional view showing the firstholding member cut along the 11C-11C line of FIG. 11A in the holdingsection of the energy treatment instrument of the treatment systemaccording to the second embodiment;

FIG. 12 is a schematic diagram showing a state in which a heater memberis fixed to the back surface of a first high-frequency electrodearranged on the first holding member of the holding section of theenergy treatment instrument in the treatment system according to thesecond embodiment;

FIG. 13 is a schematic block diagram showing the treatment systemaccording to the second embodiment;

FIG. 14 is a schematic flow chart in a case where a treatment usinghigh-frequency energy and a treatment using heat energy are performedwith respect to a living tissue by use of the treatment system accordingto the second embodiment;

FIG. 15 is a schematic graph showing the change of the impedance of theliving tissue with respect to a time when predetermined high-frequencyenergy is input into the living tissue, and also showing the change ofthe impedance of the living tissue with respect to a time when theimpedance reaches a predetermined value and then predetermined heatenergy is input instead of the high-frequency energy, in a case wherethe treatment using the high-frequency energy and the treatment usingthe heat energy are performed with respect to the living tissue by useof the treatment system according to the second embodiment;

FIG. 16 is a schematic diagram showing a modification of the treatmentsystem according to the second embodiment;

FIG. 17A is a schematic graph showing one example of an input process ofhigh-frequency energy into a living tissue with respect to time and aninput process of heat energy into the living tissue with respect totime, in a case where a treatment using the high-frequency energy and atreatment using the heat energy are performed with respect to the livingtissue by use of a treatment system according to a first modification ofthe second embodiment;

FIG. 17B is a schematic graph showing one example of the input processof the high-frequency energy into the living tissue with respect to thetime and the input process of the heat energy into the living tissuewith respect to the time, in a case where the treatment using thehigh-frequency energy and the treatment using the heat energy areperformed with respect to the living tissue by use of the treatmentsystem according to the first modification of the second embodiment;

FIG. 17C is a schematic graph showing one example of the input processof the high-frequency energy into the living tissue with respect to thetime and the input process of the heat energy into the living tissuewith respect to the time, in a case where the treatment using thehigh-frequency energy and the treatment using the heat energy areperformed with respect to the living tissue by use of the treatmentsystem according to the first modification of the second embodiment;

FIG. 17D is a schematic graph showing one example of the input processof the high-frequency energy into the living tissue with respect to thetime and the input process of the heat energy into the living tissuewith respect to the time, in a case where the treatment using thehigh-frequency energy and the treatment using the heat energy areperformed with respect to the living tissue by use of the treatmentsystem according to the first modification of the second embodiment;

FIG. 17E is a schematic graph showing one example of the input processof the high-frequency energy into the living tissue with respect to thetime and the input process of the heat energy into the living tissuewith respect to the time, in a case where the treatment using thehigh-frequency energy and the treatment using the heat energy areperformed with respect to the living tissue by use of the treatmentsystem according to the first modification of the second embodiment;

FIG. 18 is a schematic diagram showing a state in which a heater memberis fixed to the back surface of a first high-frequency electrodeprovided on a first holding member of a holding section of an energytreatment instrument in a treatment system according to a secondmodification of the second embodiment;

FIG. 19A is a schematic plan view showing a first holding member on aside close to a second holding member in a holding section of a surgicaltreatment instrument according to a third modification of the secondembodiment;

FIG. 19B is a schematic vertical sectional view showing the firstholding member cut along the 19B-19B line of FIG. 19A in the holdingsection of the surgical treatment instrument according to the thirdmodification of the second embodiment;

FIG. 19C is a schematic transverse sectional view showing the firstholding member cut along the 19C-19C line of FIG. 19A in the holdingsection of the surgical treatment instrument according to the thirdmodification of the second embodiment;

FIG. 19D is a schematic plan view showing a first holding member on aside close to a second holding member in a holding section of a surgicaltreatment instrument according to a further modification of the thirdmodification of the second embodiment;

FIG. 20A is a schematic perspective view showing a state in which twointestinal canals of a small intestine are anastomosed, and a schematicdiagram cut along the 20A-20A line of FIG. 20C described later;

FIG. 20B is a schematic diagram showing an enlarged part denoted withsymbol 20B of FIG. 20A;

FIG. 20C is a schematic diagram showing a state in which two intestinalcanals of the small intestine are anastomosed, and then the ends of theintestinal canals are closed;

FIG. 20D is a schematic diagram as a modification of FIG. 20B showingthe enlarged part denoted with the symbol 20B of FIG. 20A;

FIG. 21A is a schematic plan view showing a first holding member on aside close to a second holding member in a holding section of a surgicaltreatment instrument according to a fourth modification of the secondembodiment;

FIG. 21B is a schematic plan view showing the first holding member onthe side close to the second holding member in the holding section ofthe surgical treatment instrument according to the fourth modificationof the second embodiment;

FIG. 21C is a schematic plan view showing the first holding member onthe side close to the second holding member in the holding section ofthe surgical treatment instrument according to the fourth modificationof the second embodiment;

FIG. 22A is a schematic plan view showing the first holding member onthe side close to the second holding member in the holding section ofthe surgical treatment instrument according to a fifth modification ofthe second embodiment;

FIG. 22B is a schematic transverse sectional view cut along the 22B-22Bline of FIG. 22A and showing the first holding member in the holdingsection of the surgical treatment instrument according to the fifthmodification of the second embodiment;

FIG. 22C is a schematic transverse sectional view cut along the 22B-22Bline of FIG. 22A and showing a first holding member in a holding sectionof a surgical treatment instrument according to a further modificationof the fifth modification of the second embodiment;

FIG. 23 is a schematic diagram showing a modification of a treatmentsystem according to a third embodiment;

FIG. 24A is a schematic vertical sectional view showing a state in whicha main body side holding section and a detachable side holding sectionof an energy treatment instrument according to the third embodiment areengaged, and the detachable side holding section is disposed away fromthe main body side holding section;

FIG. 24B is a schematic vertical sectional view showing a state in whichthe main body side holding section and the detachable side holdingsection of the energy treatment instrument according to the thirdembodiment are engaged, and the detachable side holding section isengaged with the main body side holding section;

FIG. 24C is a schematic diagram showing the front surface of the mainbody side holding section of the energy treatment instrument accordingto the third embodiment; and

FIG. 25 is a schematic diagram showing the front surface of the mainbody side holding section of the energy treatment instrument accordingto a modification of the third embodiment.

DETAILED DESCRIPTION OF THE INVENTION

The best mode for carrying out this invention will hereinafter bedescribed with reference to the drawings.

First Embodiment

A first embodiment will be described with reference to FIGS. 1 to 5.

As shown in FIG. 1, a treatment system 10 includes a surgical treatmentinstrument (a treatment instrument) 12, an energy source 14 and a footswitch 16. The surgical treatment instrument 12 is connected to theenergy source 14 via, for example, a pair of connection cables 22 a, 22b for high-frequency energy output, and one connection cable 24 for heatenergy output. The foot switch 16 is connected to the energy source 14via a connection cable 26 for the switch.

The surgical treatment instrument 12 includes a pair of scissorconstituting members 32 a, 32 b; a pair of handle sections 34 a, 34 bwhich are provided on the proximal ends of the scissor constitutingmembers 32 a, 32 b and which are to be manually held and operated by anoperator; and a pair of jaws (holding members, treatment sections) 36 a,36 b which are provided on the distal ends of the scissor constitutingmembers 32 a, 32 b and which hold a living tissue L_(T) to be treated toperform a treatment such as coagulation or incision.

The pair of scissor constituting members 32 a, 32 b are superimposed sothat the members substantially intersect with each other between thedistal ends of the members and the proximal ends thereof. Anintersecting portion between the scissor constituting members 32 a and32 b is provided with a support pin 38 which rotatably connects thescissor constituting members 32 a, 32 b to each other.

The pair of handle sections 34 a, 34 b are provided with rings 42 a, 42b to be held with operator's fingers. When the operator holds the rings42 a, 42 b with operator's thumb and middle finger, respectively, toperform an opening/closing operation, the jaws 36 a, 36 b open/close inconjunction with the operation.

The pair of jaws 36 a, 36 b are provided with energy release elementsfor applying energy to the living tissue L_(T). One jaw 36 a is providedwith a first high-frequency electrode 52 a as the energy releaseelement. The other jaw 36 b is provided with a second high-frequencyelectrode 52 b and a heater member 54 as the energy release elements.Among these elements, the heater member (a heat generation element) 54is embedded in the other jaw 36 b in a state in which the member isfixed to the back surface of the second high-frequency electrode 52 b.

Thus, in the pair of jaws 36 a, 36 b, the first and secondhigh-frequency electrodes 52 a, 52 b include conductive tissue holdingfaces (tissue grasping faces). It is to be noted that the heater member54 is provided with a thin film resistance and a thick film resistanceas heat generation patterns. The thin film resistance is formed by athin film formation process such as physical vapor deposition (PVD) andchemical vapor deposition (CVD). The thick film resistance is formed bya thick film formation process such as screen printing. The heatgeneration pattern is formed of a high melting metal such as molybdenumhaving a so-called positive temperature coefficient such that anelectric resistance increases in proportion to a temperature.

In the pair of scissor constituting members 32 a, 32 b, power supplylines 62 a, 62 b for supplying electric signals to the electrodes 52 a,52 b are arranged, respectively. The power supply lines 62 a, 62 bextend from the jaws 36 a, 36 b to the handle sections 34 a, 34 b,respectively. The rings 42 a, 42 b are provided with bipolar terminals64 a, 64 b, respectively. The bipolar terminals 64 a, 64 b areelectrically connected to the power supply lines 62 a, 62 b,respectively. Therefore, in a case where the energy is supplied to theelectrodes 52 a, 52 b through the power supply lines 62 a, 62 b in astate in which the living tissue L_(T) is held between the jaws 36 a and36 b (between the electrodes 52 a and 52 b), a high-frequency current issupplied through the living tissue L_(T) between the electrodes 52 a and52 b, whereby the living tissue L_(T) generates heat.

In the other scissor constituting member 32 b of the pair of scissorconstituting members 32 a, 32 b, a power supply line 66 for supplying apower to the heater member 54 is provided. The power supply line 66extends from the jaw 36 b to the handle section 34 b. The ring 42 b isprovided with a heater member terminal 68 electrically connected to thepower supply line 66. Therefore, when the energy is supplied to theheater member 54 through the power supply line 66, the heater member 54generates heat, and the heat (heat energy) is conducted to the secondhigh-frequency electrode 52 b which comes in close contact with theheater member 54, and is transmitted to the living tissue L_(T) whichcomes in contact with the front surface of the second high-frequencyelectrode 52 b.

According to such a structure, the heater member 54 is provided on atleast one of the pair of jaws 36 a, 36 b which are supportedopenably/closably to grasp the living tissue L_(T) (it is alsopreferable to provide the heat members on both of the jaws), and theheater member functions as heat generation means capable of applying theheat energy for coagulating the living tissue L_(T) grasped between thejaws 36 a and 36 b.

Therefore, the surgical treatment instrument 12 can supply thehigh-frequency current between these electrodes 52 a and 52 b to applythe high-frequency energy to the living tissue L_(T) grasped between thejaws 36 a and 36 b. Moreover, the energy is applied to the heater member54 to generate the heat therefrom, whereby the heat energy obtained bythe heat generation of the heater member 54 can be transmitted to theliving tissue L_(T) through the second electrode 52 b to treat thetissue.

It is to be noted that the foot switch 16 includes a pedal 16 a. Whenthe pedal 16 a is pressed, the high-frequency energy and/or the heatenergy is output based on an appropriately set state (a state in whichan energy output amount, an energy output timing or the like iscontrolled). When the pressed pedal 16 a is released, the output of thehigh-frequency energy and heat energy is forcibly stopped.

As shown in FIG. 2, a high-frequency energy driving circuit 72 and aheat generation element driving circuit 74 are arranged in the energysource 14. The high-frequency energy driving circuit 72 and the heatgeneration element driving circuit 74 are connected to the energy source14 via a communication cable 82.

The high-frequency energy driving circuit 72 includes an output controlsection 92; a variable voltage source (SW power source) 94 whichsupplies a power for outputting and controlling the high-frequencyenergy; a power amplifier (AMP) 96 which amplifies a high-frequencypower and which shapes an output waveform; a sensor 98 which monitorsthe high-frequency energy output (a voltage value and a current value);and an operation display panel (setting means of the output controlsection 92) 100. Among these components, the variable voltage source (SWpower source) 94, the power amplifier 96 and the sensor 98 aresuccessively connected in series. The sensor 98 is connected to thesurgical treatment instrument 12 via the connection cables 22 a, 22 bfor the high-frequency energy output. The output control section 92 isconnected to the variable voltage source 94, the power amplifier 96 andthe sensor 98. Furthermore, the output control section 92 is connectedto the operation display panel 100. The operation display panel 100displays a high-frequency energy output amount monitored by the sensor98 through the electrodes 52 a, 52 b, and the output control section 92sends control signals to the variable voltage source 94 and theelectrode amplifier 96 based on a monitor signal from the sensor 98.Thus, the high-frequency output is controlled.

Therefore, while the power supplied from the variable voltage source 94and amplified by the power amplifier 96 is controlled by the outputcontrol section 92, the power is transmitted from the sensor 98 to theelectrodes 52 a, 52 b of the surgical treatment instrument 12 via theconnection cables 22 a, 22 b for the high-frequency energy output.

The heat generation element driving circuit 74 includes an outputcontrol section 102 for the heat generation element driving circuit, anoutput section 104, a sensor 106 and an operation display panel 108. Theoutput section 104 supplies a power (energy) for allowing the heatermember 54 to generate heat. The sensor 106 monitors the value of theoutput to the heater member 54 (a voltage value, a current value), andsends a monitor signal to the output control section 102. The outputcontrol section 102 calculates various parameters such as a voltage, acurrent, a power and a resistance value based on the monitor signal fromthe sensor 106.

It is to be noted that the heat generation pattern of the heater member54 has a positive temperature coefficient. Therefore, the output controlsection 102 can further calculate a temperature T of the heater member54 from the calculated resistance value. The output control section 102sends a control signal to the output section 104 based on thecalculation results of the parameters. Therefore, the output control ofthe heater member 54 is performed.

The output control section 92 of the high-frequency energy drivingcircuit 72 is connected to the output control section 102 of the heatgeneration element driving circuit 74 via the communication cable 82capable of bidirectionally transmitting signals. The output controlsection 92 of the high-frequency energy driving circuit 72 sends theON/OFF signal of the foot switch 16 to the output control section 102 ofthe heat generation element driving circuit 74. The output controlsection 92 of the high-frequency energy driving circuit 72 sends, to theoutput control section 102 of the heat generation element drivingcircuit 74, a signal indicating the magnitude of an impedance (animpedance in a state in which the living tissue L_(T) is held betweenthe electrodes 52 a and 52 b) Z during the output of the high-frequencyenergy calculated based on the monitor signal (the voltage value, thecurrent value) of the sensor 98. It is to be noted that the impedance Zis calculated by the output control section 92 based on the monitorsignal from the sensor 98. Therefore, the electrodes 52 a, 52 b and thehigh-frequency energy driving circuit 72 are high-frequency energyoutput sections for use in exerting the high-frequency energy to theliving tissue L_(T) grasped between the jaws 36 a and 36 b to denaturethe living tissue L_(T) and collecting the impedance information Z(biological information) of the living tissue L_(T).

The output control section 102 of the heat generation element drivingcircuit 74 sends, to the output control section 92 of the high-frequencyenergy driving circuit 72, a signal indicating the temperature T of theheater member 54 calculated based on the monitor signal (the voltagevalue, the current value) of the sensor 106. The operation display panel100 of the high-frequency energy driving circuit 72 is connected to theoperation display panel 108 of the heat generation element drivingcircuit 74 via the output control section 92 of the high-frequencyenergy driving circuit 72, the communication cable 82 and the outputcontrol section 102 of the heat generation element driving circuit 74.Therefore, the settings and display contents of the operation displaypanels 100, 108 are associated with each other.

As described above, the surgical treatment instrument 12 of theembodiment functions as a bipolar high-frequency treatment instrument asshown in FIGS. 2 and 3A, and functions as the treatment instrument forthe heat generation as shown in FIG. 2.

A method for using the treatment system 10 (an operation) willhereinafter be described.

An operator operates the operation display panels (setting means) 100,108 before the treatment of a patient, to input and set, into the outputcontrol sections 92, 102, the output conditions (a set power Pset[W] ofthe high-frequency energy output, a set temperature Tset [° C.] of theheat energy output, threshold values Z1, Z2 of the impedance Z of theliving tissue L_(T), etc.) of the surgical treatment instrument 12. Thethreshold value Z1 is preferably set in a state in which when the dryingof the living tissue L_(T) proceeds and the value of the impedance Zrises, the high-frequency energy output lowers, and appropriate energycannot be introduced, or a state slightly previous to this state. Onsuch conditions, the threshold value Z1 is set to an empiricallyappropriate value. With regard to the threshold value Z2, on suchconditions that the drying of the living tissue L_(T) further proceeds,the threshold value Z2 is set to an empirically appropriate value. It isto be noted that the threshold values Z1, Z2 may be incorporated in aprogram stored in the output control section 92 in advance, and does notnecessarily have to be set by the operator.

It is to be noted that with regard to a relation between the thresholdvalues Z1 and Z2 of the impedance Z, the threshold value Z2 is largerthan the threshold value Z1. The threshold value Z1 is preferably, forexample, about 500[Ω] to 1500[Ω], and the threshold value Z2 ispreferably about 2000[Ω] to 3000[Ω]. It is also preferable that thethreshold values Z1, Z2 are set within predetermined ranges (e.g., thethreshold value Z1 is in a range of 500[Ω] to 1500[Ω], and the thresholdvalue Z2 is in a range of 2000[Ω] to 3000[Ω]) and that values out of thepredetermined ranges cannot be set.

The operator holds with fingers the rings 42 a, 42 b of the handlesections 34 a, 34 b of the surgical treatment instrument 12, andoperates the surgical treatment instrument 12 to peel, from a peripheralliving tissue, the living tissue L_(T) to be subjected to a treatmentsuch as coagulation or incision. Thus, the holding of the living tissueL_(T) as a treatment target is facilitated. Then, the living tissueL_(T) is held and grasped between the jaws 36 a and 36 b.

Subsequently, the operator performs an operation of pressing the pedal16 a of the foot switch 16, while maintaining a state in which theliving tissue L_(T) is held between the jaws 36 a and 36 b. Inconsequence, the treatment is performed using the high-frequency energyapplied to the living tissue L_(T) between the electrodes 52 a and 52 bof the jaws 36 a and 36 b of the surgical treatment instrument 12, orthe heat energy transmitted through the electrode 52 a from the heatermember 54 which has generated the heat from the energy applied to theheater member 54.

FIG. 4 shows one example of the control flow of the surgical treatmentinstrument 12 controlled by the high-frequency energy driving circuit 72and the heat generation element driving circuit 74.

First, the output control section 92 of the high-frequency energy outputcircuit 72 judges whether or not the pedal 16 a of the foot switch 16has been pressed by operator's operation based on the signal from theswitch 16, that is, whether or not the switch has been turned on (STEP1).

In a case where the output control section 92 judges that the switch 16has been turned on, the output control section outputs thehigh-frequency energy between the electrodes 52 a and 52 b of the jaws36 a and 36 b of the surgical treatment instrument 12 from the variablevoltage source 94 of the high-frequency energy driving circuit 72 viathe power amplifier 96, the sensor 98 and the connection cables 22 a, 22b for the high-frequency energy output (STEP 2). At this time, theoutput control section supplies the set power Pset [W] preset by theoperation display panel 100, that is, a power of, for example, about 20[W] to 80 [W] between the electrodes 52 a and 52 b of the jaws 36 a and36 b (STEP 3).

Therefore, the first high-frequency electrode 52 a supplies ahigh-frequency current between the first high-frequency electrode 52 aand the second high-frequency electrode 52 b via the living tissue L_(T)as the treatment target. That is, the high-frequency energy is appliedto the living tissue L_(T) grasped between the electrodes 52 a and 52 b.Therefore, Joule heat is generated in the living tissue L_(T) graspedbetween the electrodes 52 a and 52 b to heat the living tissue L_(T)itself. A cell membrane in the living tissue L_(T) held between theelectrodes 52 a and 52 b is destroyed owing to the function of thehigh-frequency voltage and the function of the Joule heat to releasesubstances from the cell membrane, and the tissue is homogenized withextracellular components including collagen. The high-frequency currentis supplied through the living tissue L_(T) between the electrodes 52 aand 52 b, so that further Joule heat acts on the tissue L_(T)homogenized in this manner, and, for example, the bonding faces of theliving tissue L_(T) or the layers of the tissue are bonded to eachother. Therefore, when the high-frequency current is supplied betweenthe electrodes 52 a and 52 b, the living tissue L_(T) itself generatesthe heat and is dehydrated, while the inside of the living tissue L_(T)is denatured (the living tissue L_(T) is cauterized).

At this time, the impedance Z of the living tissue L_(T) held betweenthe electrodes 52 a and 52 b is measured by the sensor (collection meansfor collecting the biological information) 98 through the electrodes 52a, 52 b. An impedance Z0 at a time of treatment start changes inaccordance with the sizes or shapes of the electrodes, but as shown inFIG. 5, the impedance is, for example, about 60[Ω]. Subsequently, whenthe high-frequency current is supplied through the living tissue L_(T)to cauterize the living tissue L_(T), the value of the impedance Z oncelowers and then rises. Such rise of the value of the impedance Zindicates that a water content is removed from the living tissue L_(T)and that the tissue progressively dries.

Subsequently, the output control section 92 judges whether or not thevalue of the impedance Z during the high-frequency energy outputcalculated based on the signal from the sensor 98 exceeds the presetthreshold value Z1 (here, about 1000[Ω] as shown in FIG. 5) (STEP 4). Asthe threshold value Z1, there is selected a value or so which hasempirically been known and at which the rise ratio of the value of theimpedance Z becomes dull at a time when a predetermined power is input.Then, in a case where the output control section 92 judges that thevalue of the impedance Z is smaller than the threshold value Z1,processing is returned to STEP 3. That is, the high-frequency energy forthe treatment is continuously applied to the living tissue L_(T) heldbetween the electrodes 52 a and 52 b of the jaws 36 a and 36 b.

On the other hand, in a case where the output control section 92 judgesthat the value of the impedance Z is the threshold value Z1 or more, theoutput control section 92 reduces the high-frequency energy outputsupplied to the electrodes 52 a, 52 b, and switches the output tomonitor output (STEP 5).

Here, the monitor output is the output of a weak high-frequency currenthaving such a level that the living tissue L_(T) is not treated. Owingto such monitor output, the change of the impedance Z of the livingtissue L_(T) between the jaws 36 a and 36 b can continuously bemonitored with the sensor 98 through the electrodes 52 a, 52 b.

Subsequently, in a case where the output control section 92 judges thatthe value of the impedance Z is the threshold value Z1 or more, a signalis transmitted from the output control section 92 of the high-frequencyenergy driving circuit 72 to the output control section 102 of the heatgeneration element driving circuit 74 via the communication cable 82.Then, the output control section 102 of the heat generation elementdriving circuit 74 supplies the power (the energy) to the heater member54 so that the temperature of the heater member 54 is a presettemperature Tset [° C.], for example, a temperature of 100 [° C.] to 300[° C.] (STEP 5). In consequence, the heater member 54 generates heat.The heat is conducted from the heater member 54 to the second electrode52 b, and the heat (the heat energy) conducted to the second electrode52 b coagulates the living tissue L_(T) internally from the side of thefront surface of the living tissue L_(T) which comes in contact with thesecond electrode 52 b. At this time, the living tissue (protein) isintegrally denatured, and the water content as a factor for disturbingthe mutual bonding of proteins is removed. The high-frequency energy issubstantially simultaneously switched to the heat energy, and the cellmembrane is destroyed by the high-frequency energy, whereby thermalconductivity improves, and hence the heat can more efficiently beconducted from the heater member 54 to the living tissue.

Subsequently, the output control section 92 judges whether the impedanceZ of the living tissue L_(T) monitored in accordance with the monitoroutput is the preset threshold value Z2 (here, about 2000[Ω] as shown inFIG. 5) or more (STEP 6). In a case where it is judged that theimpedance Z is smaller than the threshold value Z2, the processing isreturned to STEP 4. On the other hand, in a case where it is judged thatthe value of the impedance Z exceeds the threshold value Z2, the outputcontrol sections 92, 102 stop the output of the high-frequency energyand heat energy (STEP 7). Then, the treatment of the living tissue L_(T)by use of the treatment system 10 is ended.

It is to be noted that while a series of treatments to output thehigh-frequency energy and the heat energy in this manner are performed,the pedal 16 a of the foot switch 16 is depressed. When the depressedpedal 16 a is released during the treatment, the output of thehigh-frequency energy and heat energy is forcibly stopped.

As described above, according to this embodiment, the following effectis obtained.

The high-frequency energy is introduced into the living tissue L_(T)held between the electrodes 52 a and 52 b to generate the Joule heat inthe living tissue L_(T), whereby the cell membrane is destroyed tohomogenize intracellular and extracellular components, and the tissue iscauterized, whereby the impedance Z can be raised. Then, the livingtissue L_(T) into which the high-frequency energy is introduced todestroy the cell membrane and raise the thermal conductivity can besubjected to a coagulation treatment using the heat energy conductedfrom the heater member 54 allowed to generate the heat.

At this time, the state (the impedance Z or the temperature T) of theliving tissue L_(T) held between the jaws 36 a and 36 b is monitored,and a time to switch the introduction of the energy from theintroduction of the high-frequency energy to the introduction of theheat energy can automatically be judged and switched in accordance withthe preset threshold value Z1 of the impedance Z. In consequence, aseries of operations of switching the treatment using the high-frequencyenergy to the treatment using the heat energy can be realized, so thatthe treatment can efficiently be performed.

That is, the change of the impedance Z of the high-frequency energyoutput is measured with the sensor 98 of the high-frequency energydriving circuit 72, and appropriate treatments (the treatment using thehigh-frequency energy and the treatment using the heat energy) can beperformed based on the measured value. Therefore, the threshold valuesZ1, Z2 are measured in this manner, whereby the operator can perform thetreatment in accordance with the tissue denatured state of the livingtissue L_(T) by use of the surgical treatment instrument 12, and thefluctuation of the treatment due to operator's sense can be prevented tohomogenize (stabilize) the tissue.

Therefore, in a case where the high-frequency energy is combined withthe heat conduction from the heat energy to treat the living tissueL_(T) grasped between the jaws 36 a and 36 b in a state in which theintroduction timing of the high-frequency energy and heat energy iscontrolled, the living tissue can efficiently and stably be denatured(the tissue can be cauterized and/or coagulated, etc.). The treatment isperformed in this manner, whereby the living tissue L_(T) can be treatedin a state in which loss during the introduction of the energy isminimized, and treatment time can be reduced. Therefore, a burdenimposed on the patient can largely be reduced.

The pedal 16 a of the foot switch 16 is simply pressed in a state inwhich the living tissue L_(T) is held between the electrodes 52 a and 52b of the jaws 36 a and 36 b, whereby both the treatment using thehigh-frequency energy and the treatment using the heat energy canautomatically be performed without being laboriously switched. That is,treatment conditions such as the output Pset, the temperature Tset andthe threshold values Z1, Z2 of the impedance Z are set in accordancewith the type and state of the living tissue L_(T) in the display panels100, 108, and the living tissue L_(T) as the treatment target isgrasped. Afterward, the pedal 16 a of the switch 16 simply continues tobe pressed, whereby the treatment can be performed without requiring anyoperator's sense. Subsequently, when the threshold value Z2 exceeds theset value, in a state in which the treatment of the living tissue L_(T)is prevented from being excessively performed, the treatment canautomatically be ended without requiring any artificial switchingbetween the treatment using the high-frequency energy and the treatmentusing the heat energy. Therefore, the burden imposed on the operatorduring the treatment can largely be reduced.

It is to be noted that the threshold value Z1 is the rise value, but thetiming to switch to the heat energy may be set to the lowermost point orso of the impedance at which the destruction of the cell membranesubstantially ends.

Moreover, in this embodiment, the treatment has been described in whichthe high-frequency energy is introduced into the living tissue L_(T),and then the heat energy is applied. However, the heat energy may beintroduced simultaneously with or prior to the high-frequency energy tosuch an extent that the denaturation of the protein is not caused.However, it is not appropriate to supply the heat energy which causesthe protein denaturation (the denaturation, coagulation or the like ofthe surface tissue) before supplying the treatment high-frequency energyfor treating the living tissue, because the appropriate high-frequencyenergy is not easily introduced into the living tissue.

Furthermore, in this embodiment, it is judged in STEP 6 of FIG. 4whether the value of the impedance Z is the threshold value Z2 or more,and the output of the high-frequency energy and heat energy is stopped.Separately, with the elapse of time after shifting to STEP 5, forexample, with the elapse of 30 seconds (predetermined time t) afterstarting the output of the heat generation element set temperature Tset[° C.] in STEP 5, the output of the high-frequency energy and heatenergy may automatically be stopped. That is, instead of judging thechange of the impedance Z, it is preferable to switch the treatment fromthe treatment using the high-frequency energy to the treatment using theheater member 54 after the elapse of the predetermined time t or to setthe state of the treatment by use of the display panels 100, 108 inaccordance with the elapse of time so that the treatment is ended. It isfurther preferable to set both the impedance Z and the time by use ofthe display panels 100, 108 so that one of the impedance and the timewhose treatment earlier ends is appropriately selected. The treatmentmay be ended, for example, at a time when the value of the impedance Zreaches the threshold value Z2 before the predetermined time t elapses,or the treatment may be ended at a time when the predetermined time telapses before the value of the impedance Z reaches the threshold valueZ2.

Here, it has been described that as shown in FIG. 3A, the bipolarsurgical treatment instrument 12 having the electrodes 52 a, 52 bprovided on the jaws 36 a, 36 b, respectively, and having differentpotentials is used in performing the high-frequency energy treatment,but as shown in FIG. 3B, a monopolar surgical treatment instrument forperforming the high-frequency energy treatment may preferably be used.In this case, a return electrode plate 130 is attached to a patient P tobe treated. This return electrode plate 130 is connected to an energysource 14 via an energization line 132. Furthermore, an electrode 52 aprovided on one jaw 36 a and an electrode 52 b provided on the other jaw36 b have an equal potential state in which first and second powersupply lines 62 a, 62 b are electrically connected. In this case, theareas of a living tissue L_(T) which come in contact with the first andsecond high-frequency electrodes 52 a, 52 b are small, respectively, sothat a current density is high, but the current density of the returnelectrode plate 130 lowers. Therefore, the living tissue L_(T) graspedbetween the jaws 36 a and 36 b is heated, whereas the living tissueL_(T) which comes in contact with the return electrode plate 130 isheated less to a negligible degree. Therefore, the only portions of theliving tissue L_(T) that are grasped between the jaws 36 a and 36 b andthat come in contact with the electrodes 52 a, 52 b are heated anddenatured.

Moreover, although not shown, the high-frequency electrode maypreferably be provided on the only one of the jaws 36 a, 36 b in a casewhere the monopolar surgical treatment instrument is used.

Furthermore, it is also preferable to set the output conditions of thesurgical treatment instrument 12 (the set power Pset [W] of thehigh-frequency energy output, the set temperature Tset [° C.] of theheat energy output, the threshold values T1, T2 of the set temperatureTset of the living tissue L_(T), etc.).

First Modification of First Embodiment

Next, a first modification will be described with reference to FIGS. 5Aand 5B. This modification is the modification of the first embodiment,and the description of the same members as those described in the firstembodiment or members producing the same function as that of the firstembodiment is omitted. This hereinafter applies to second to fourthmodifications.

In the above first embodiment, it has been described that the change ofthe impedance Z is measured to judge the state of the living tissueL_(T), but a phase change (a phase difference Δθ) may be judged toswitch a treatment from a treatment using high-frequency energy to atreatment using a heat generation element or to end the treatment. Inthis case, the sensor 98 shown in FIG. 2 includes a voltage detectingsection 142, a current detecting section 144 and a phase detectingsection 146 as shown in FIG. 5A.

When a high-frequency voltage is generated from a variable voltagesource 94 through a power amplifier 96, a high-frequency current havinga predetermined frequency and a peak value based on the high-frequencyvoltage transmitted through the power amplifier 96 is output to asurgical treatment instrument 12 via the current detecting section 144.The voltage detecting section 142 detects the peak value of thehigh-frequency voltage transmitted through the power amplifier 96, andthe detected peak value is output as output voltage value information tothe phase detecting section 146. The current detecting section 144detects the peak value of the high-frequency current generated based onthe high-frequency voltage transmitted through the power amplifier 96,and outputs the detected peak value as output current value informationto the phase detecting section 146.

The phase detecting section 146 detects the phase of the high-frequencyvoltage output through the power amplifier 96 based on the outputvoltage value information output from the voltage detecting section 142,and then outputs, to an output control section 92, the detected phase asoutput voltage phase information together with the output voltage valueinformation. The phase detecting section 146 detects the phase of thehigh-frequency current transmitted through the power amplifier 96 basedon the output current value information output from the currentdetecting section 144, and then outputs, to the output control section92, the detected phase as output current phase information together withthe output current value information.

The output control section 92 calculates the phase difference Δθ betweenthe high-frequency voltage and the high-frequency current output throughthe power amplifier 96 based on the output voltage value information,the output voltage phase information, the output current valueinformation and the output current phase information output from thephase detecting section 146.

The output control section 92 performs control to change the outputstate of the high-frequency current and the high-frequency voltage to anON-state or OFF-state with respect to the variable voltage source 94 andpower amplifier 96 based on an instruction signal output in accordancewith the operation of a pedal 16 a of a foot switch 16, and thecalculated phase difference Δθ.

As shown in FIG. 5B, the phase difference Δθ between the high-frequencycurrent and the high-frequency voltage output through the poweramplifier 96 is 0° or substantially 0° in an initial stage in which theliving tissue L_(T) is treated. It is to be noted that the value of thephase difference Δθ is set to 90° or a value close to 90° in a displaypanel 100.

When the pedal 16 a of the foot switch 16 is continuously pressed andthe treatment of the living tissue L_(T) grasped between electrodes 52 aand 52 b of jaws 36 a and 36 b proceeds, a water content is removed fromthe living tissue L_(T), and the tissue L_(T) is cauterized orcoagulated. When the treatment proceeds in this manner, the phasedifference Δθ between the high-frequency voltage and the high-frequencycurrent output through the power amplifier 96 increases from the stateof 0° or substantially 0° at, for example, appropriate time t1.

Afterward, when the pedal 16 a of the foot switch 16 is furthercontinuously pressed and the treatment of a desired portion proceeds,the value of the phase difference Δθ calculated by the output controlsection 92 has a constant value around 90° shown in FIG. 5B, forexample, after time t2.

Here, it is assumed that the threshold value of the phase difference Δθis set to the value close to 90° in the display panel 100. Inconsequence, the output control section 92 reduces the output ofhigh-frequency energy to provide monitor output, and transmits a signalto an output control section 102 of a heat generation element drivingcircuit 74, whereby energy is supplied from an output section 104 to aheater member 54, thereby allowing the heater member 54 to generateheat. At this time, when predetermined time (time from the time t2 tothe end of the treatment) is set in, for example, an operation displaypanel 108, a series of treatments end even in a state in which the pedal16 a of the foot switch 16 is continuously pressed.

It is to be noted that in this modification, the output control section92 may not only perform the above control in a case where it is detectedthat the phase difference Δθ is the constant value around 90° but alsoperform the above control, for example, in a case where it is detectedthat the phase difference Δθ becomes constant at a predetermined valuewhich is larger than 45° and which is 90° or less.

Moreover, both the change of the impedance Z and the change of the phasemay be combined to switch the energy to be introduced into the livingtissue L_(T). That is, with regard to the change of the impedance Z andthe change of the phase, it is also preferable that one of the impedanceand the phase which reaches the threshold value earlier or later isappropriately set and used in the display panels 100, 108. Furthermore,to switch the energy to be introduced into the living tissue L_(T), theenergy may be switched from the high-frequency energy to heat energy, orthe energy may be switched so that the heat energy is output togetherwith the high-frequency energy.

It is to be noted that in the following modifications and embodiments,an example will mainly be described in which the high-frequency energyor the heat energy is switched using the changes of the threshold valuesZ1, Z2 of the impedance Z, but the output of the high-frequency energyor heat energy may be switched using the phase difference Δθ.Alternatively, the changes of the impedance Z and phase difference Δθmay be combined to switch the output of the high-frequency energy orheat energy.

Second Modification of First Embodiment

Next, a second modification will be described with reference to FIG. 6.

An operator operates operation display panels 100, 108 in advance to setthe output conditions of a surgical treatment instrument 12 (a set powerPset [W] of high-frequency energy output, a set temperature Tset [° C.]of heat energy output, threshold values Z1, Z2 of the set power Pset,etc.).

FIG. 6 shows one example of the control flow of the surgical treatmentinstrument 12 controlled by a high-frequency energy driving circuit 72and a heat generation element driving circuit 74.

First, an output control section 92 of the high-frequency energy drivingcircuit 72 judges whether or not a foot switch 16 has been turned on byoperator's operation (STEP 11).

In a case where it is judged that the switch 16 has been turned on,high-frequency energy is output to a living tissue L_(T) betweenelectrodes 52 a and 52 b of jaws 36 a and 36 b of the surgical treatmentinstrument 12, and a heater member 54 is allowed to generate heat (STEP12).

Then, the set power Pset [W] preset by the operation display panel 100,for example, a power of, for example, about 20 [W] to 80 [W] is suppliedbetween the electrodes 52 a and 52 b of the jaws 36 a and 36 b, and themonitor output of the heater member 54 is started (STEP 13). The monitoroutput indicates that the energy is applied to such a level that theliving tissue L_(T) is not treated to allow the heater member 54 togenerate the heat. A sensor 106 monitors a temperature T of the heatermember 54 in accordance with such monitor output. Then, the outline ofthe temperature change of the living tissue L_(T) transmitted from theliving tissue L_(T) between the jaws 36 a and 36 b through the electrode52 b can be monitored. That is, the heater member 54 is allowed tofunction as a temperature sensor, and the cauterizing of the livingtissue L_(T) grasped between the jaws 36 a and 36 b is started by thehigh-frequency energy supplied from the high-frequency energy drivingcircuit 72.

An output control section 102 of the heat generation element drivingcircuit 74 judges whether the temperature T calculated based on a signalfrom the sensor 106 (the temperature of the heat conducted from theliving tissue L_(T) through the electrode 52 b) is a preset thresholdvalue T1 (e.g., 100° C.) or more (STEP 14). In a case where it is judgedthat the temperature T is lower than the preset threshold value T1,processing is returned to STEP 13. On the other hand, in a case where itis judged that the temperature T is the preset threshold value T1 ormore, the output control section 102 of the heat generation elementdriving circuit 74 transmits a signal to the output control section 92of the high-frequency energy driving circuit 72 via a communicationcable 82. The output control section 92 reduces the high-frequencyenergy output to switch the output to the monitor output. A sensor 98can monitor the change of the impedance Z of the living tissue L_(T)between the jaws 36 a and 36 b in accordance with the monitor output.Then, the output control section 102 of the heat generation elementdriving circuit 74 supplies the energy to the heater member 54 so thatthe temperature of the heater member 54 is a preset temperature Tset [°C.], for example, a temperature of 100 [° C.] to 300 [° C.] (STEP 15).Therefore, the living tissue L_(T) grasped between the jaws 36 a and 36b conducts the heat to the second electrode 52 b owing to the heatconduction from the heater member 54, and the heat coagulates the livingtissue L_(T) internally from the side of the front surface of the livingtissue L_(T) which comes in close contact with the second electrode 52b.

Subsequently, the output control section 92 judges whether the impedanceZ of the living tissue L_(T) monitored in accordance with the monitoroutput is the preset threshold value Z2 or more (STEP 16). In a casewhere it is judged that the impedance Z is smaller than the thresholdvalue Z2, the processing is returned to STEP 15. On the other hand, in acase where it is judged that the value of the impedance Z is thethreshold value Z2 or more, the output control sections 92, 102 stop theoutput of the high-frequency energy and heat energy (STEP 17). Inconsequence, the treatment of the living tissue L_(T) is completed.

Third Modification of First Embodiment

Next, a third modification will be described with reference to FIG. 7.In this modification, a heater member 54 is used as a temperaturesensor.

FIG. 7 shows one example of the control flow of a surgical treatmentinstrument 12 controlled by a high-frequency energy output circuit 72and a heat generation element driving circuit 74. Here, the processingof STEP 21 to STEP 24 is the same as that of the second modificationshown in FIG. 6. That is, STEP 21 of FIG. 7 corresponds to STEP 11 ofFIG. 6, STEP 22 corresponds to STEP 12, STEP 23 corresponds to STEP 13,and STEP 24 corresponds to STEP 14. It is judged in STEP 24 whether atemperature T of a living tissue L_(T) is a preset threshold value T1(e.g., T1 is about 100° C.) or more. In a case where it is judged thatthe temperature T is lower than the threshold value T1, processing isreturned to STEP 23. In a case where it is judged that the temperature Tis the threshold value T1 or more, the processing shifts to STEP 25 tocomplete the treatment of the living tissue L_(T).

Fourth Modification of First Embodiment

Next, a fourth modification will be described with reference to FIG. 8.This modification is an example in which unlike the heat generationelement driving circuit 74 described in the first embodiment, atemperature sensor (not shown) is provided separately from a heatermember 54. That is, in this modification, the heater member 54 is notused as the temperature sensor and, for example, the temperature of aliving tissue L_(T) is measured by another temperature sensor. Theheater member 54 is formed of a material such as Ni—Cr or Fe—Cr. Atemperature sensor such as a thermistor or a thermocouple is provided inthe vicinity of the heater member 54.

The heat generation element driving circuit 74 is provided with anoutput section 104 which supplies a power for allowing the heater member54 to generate heat. The output section 104 is connected to a surgicaltreatment instrument 12 via a connection cable 24 a for heat energyoutput. The heat generation element driving circuit 74 is also providedwith a sensor 106. The sensor 106 is connected to the temperature sensorprovided separately from the heater member 54 of the surgical treatmentinstrument 12 via a connection cable 24 b for the temperature sensor.Therefore, the sensor 106 transmits a signal indicating a temperature Tof the heater member 54 to an output control section 102 based on asignal from the temperature sensor provided separately from the heatermember 54. The output control section 102 sends a signal to the outputsection 104 based on the signal from the sensor 106. In consequence, theoutput control of the heater member 54 is performed.

Second Embodiment

Next, a second embodiment will be described with reference to FIGS. 9 to15. This embodiment is the modification of the first embodiment.

Here, as the example of an energy treatment instrument (a treatmentinstrument), a linear surgical treatment instrument 212 for performing atreatment through, for example, an abdominal wall will be described.

As shown in FIG. 9, a treatment system 210 includes the energy treatmentinstrument 212, an energy source 214 and a foot switch 216.

The energy treatment instrument 212 includes a handle 222, a shaft 224and an openable/closable holding section 226. The handle 222 isconnected to the energy source 214 via a cable 228. The energy source214 is connected to the foot switch (may be a hand switch) 216 having apedal 216 a. In consequence, the pedal 216 a of the foot switch 216 isoperated by an operator to turn on/off the supply of energy from theenergy source 214 to the surgical treatment instrument 212.

The handle 222 is formed into such a shape that the operator easilyholds the handle, and is substantially formed into an L-shape. One endof the handle 222 is provided with the shaft 224. The cable 228 extendsfrom the proximal end of the handle 222 disposed coaxially with respectto this shaft 224.

On the other hand, the other end side of the handle 222 is a graspingsection to be grasped by the operator. The handle 222 is provided with aholding section opening/closing knob 232 so that the knob 232 isarranged on the other end side of the handle. The holding sectionopening/closing knob 232 is connected to the proximal end of a sheath244 (see FIGS. 10A and 10B) of the shaft 224 in the substantially middleportion of the handle 222 as described later. When the holding sectionopening/closing knob 232 comes close to or away from the other end ofthe handle 222, the sheath 244 moves along the axial direction of thesheath. The handle 222 further includes a cutter driving knob 234 formoving a cutter 254 described later in a state in which the knob 234 isarranged in parallel with the holding section opening/closing knob 232.

As shown in FIGS. 10A and 10B, the shaft 224 includes a cylindricalmember 242, and the sheath 244 slidably arranged outside the cylindricalmember 242. The proximal end of the cylindrical member 242 is fixed tothe handle 222 (see FIG. 9). The sheath 244 is slidable along the axialdirection of the cylindrical member 242.

A recessed portion 246 is formed along the axial direction of thecylindrical member 242 outside the cylindrical member 242. The recessedportion 246 is provided with a first high-frequency electrodeenergization line 266 b connected to a first high-frequency electrode(an output section) 266 described later, and a heater memberenergization line 268 a connected to a heater member 268. Ahigh-frequency electrode energization line 270 b connected to a secondhigh-frequency electrode (an output section) 270 described later isinserted through the cylindrical member 242.

A driving rod 252 is arranged in the cylindrical member 242 of the shaft224 so that the rod 252 can move along the axial direction thereof. Thedistal end of the driving rod 252 is provided with the thin-plate-likecutter (an auxiliary treatment instrument) 254. Therefore, when thecutter driving knob 234 is operated, the cutter 254 moves via thedriving rod 252.

The distal end of the cutter 254 is provided with a blade 254 a, and thedistal end of the driving rod 252 is fixed to the proximal end of thecutter 254. A long groove 254 b is formed between the distal end of thecutter 254 and the proximal end thereof. In this long groove 254 b, amovement regulation pin 256 extending in a direction crossing the axialdirection of the shaft 224 at right angles is fixed to the cylindricalmember 242 of the shaft 224. Therefore, the long groove 254 b of thecutter 254 moves along the movement regulation pin 256. In consequence,the cutter 254 moves straight. At this time, the cutter 254 is providedin cutter guide grooves (channels, fluid discharge grooves) 262 a, 264 aof a first holding member 262 and a second holding member 264 describedlater.

It is to be noted that engagement portions 254 c which engage with themovement regulation pin 256 to control the movement of the cutter 254are formed in at least three portions, that is, in one end and the otherend of the long groove 254 b of the cutter 254 and between the one endand the other end.

As shown in FIGS. 9, 10A and 10B, the holding section 226 is provided onthe distal end of the shaft 224. As shown in FIGS. 10A and 10B, theholding section 226 includes the first holding member (a first jaw) 262and the second holding member (a second jaw) 264.

The first holding member 262 and the second holding member 264themselves preferably entirely have insulation properties, respectively.The first holding member 262 is integrally provided with a first holdingmember main body (hereinafter referred to mainly as the main body) 272and a base portion 274 provided on the proximal end of the main body272. The first holding member main body 272 and the base portion 274 areprovided with the cutter guide groove 262 a for guiding the cutter 254.Then, the main body 272 is provided with the first high-frequencyelectrode 266 and the heater member 268. That is, the first holdingmember 262 is provided with the first high-frequency electrode 266 andthe heater member 268 as an output member and an energy release section.

As shown in FIGS. 10A to 12, the main body 272 of the first holdingmember 262 is provided with a recessed portion 272 a and a holding face272 b including the edge of the recessed portion 272 a. The firsthigh-frequency electrode 266 is arranged in the recessed portion 272 a.The front surface of the first high-frequency electrode 266 and theholding face 272 b are different surfaces. The holding face 272 b isarranged closer to a main body 276 of the facing second holding member264 than the front surface of the first high-frequency electrode 266 is,and the holding face abuts on a holding face 276 b of the main body 276of the facing second holding member 264.

The first high-frequency electrode 266 is electrically connected to afirst electrode connector 266 a. The first electrode connector 266 a isconnected to the cable 228 extending from the handle 222 via theenergization line 266 b for the first high-frequency electrode 266. Theheater member 268 is connected to the cable 228 extending from thehandle 222 via the energization line 268 a for the heater member 268.The main body 276 of the second holding member 264 is provided with thesecond high-frequency electrode 270. The second high-frequency electrode270 is electrically connected to a second electrode connector 270 a. Thesecond electrode connector 270 a is connected to the cable 228 extendingfrom the handle 222 via the energization line 270 b for the secondhigh-frequency electrode 270.

As shown in FIGS. 11A and 12, the first high-frequency electrode 266 iscontinuously formed into, for example, a substantial U-shape so that theelectrode 266 has two ends in the proximal end of the main body 272 ofthe first holding member 262. In consequence, the first high-frequencyelectrode 266 is provided with the cutter guide groove (convenientlydenoted with symbol 262 a) which guides the cutter 254 together with thefirst holding member 262.

The heater members 268 are provided on the back surface of the firsthigh-frequency electrode 266 in a discrete manner. At this time,portions between the first high-frequency electrode 266 and the heatermembers 268 are insulated. Subsequently, when the heater member 268generates heat, the heat is conducted to the first high-frequencyelectrode 266. In consequence, the living tissue L_(T) which comes incontact with the first high-frequency electrode 266 is cauterized.

It is to be noted that the insulating main body 272 of the first holdingmember 262 preferably covers the outer periphery of the heater member268, and has an insulation property. According to such a structure, whenthe heat generated by the heater member 268 is conducted to the firsthigh-frequency electrode 266, the heat can be conducted in a state inwhich a heat loss is reduced.

The second holding member 264 integrally includes the second holdingmember main body 276 and a base portion 278 provided on the proximal endof the main body 276. The second holding member main body 276 and thebase portion 278 are provided with the cutter guide groove 264 a forguiding the cutter 254. The second main body 276 is provided with thesecond high-frequency electrode 270. That is, the second holding member264 is provided with the second high-frequency electrode 270 as anoutput member or an energy release member.

Although not shown, the second high-frequency electrode 270 iscontinuously formed into, for example, a substantial U-shape (the sameshape) symmetrically with the first high-frequency electrode 266 shownin FIG. 11A so that the electrode 270 has two ends in the proximal endof the main body 276 of the second holding member 264. In consequence,the second high-frequency electrode 270 is provided with the cutterguide groove (conveniently denoted with symbol 264 a) which guides thecutter 254.

It is to be noted that the cutter guide grooves 262 a, 264 a of thefirst and second holding members 262, 264 are formed in a state in whichthe grooves 262 a, 264 a face each other, and the grooves 262 a, 264 aare formed along the axial direction of the shaft 224. Then, the twocutter guide grooves 262 a, 264 a can guide one cutter 254.

The cylindrical member 242 and the sheath 244 of the shaft 224 of theenergy treatment instrument 212 shown in FIGS. 10A and 10B are providedwith fluid discharge ports 242 a, 244 a via which a fluid such as vapor(a gas) or a liquid (a tissue liquid) described later is discharged.These fluid discharge ports 242 a, 244 a are formed in the proximal endof the shaft 224.

Here, although not shown, the outer peripheral surface of the fluiddischarge port 244 a of the sheath 244 is preferably provided with aconnection mouthpiece. At this time, the fluid described later isdischarged through the cutter guide grooves 262 a, 264 a, the fluiddischarge port 242 a of the cylindrical member 242 of the shaft 224, thefluid discharge port 244 a of the sheath 244 of the shaft 224 and theconnection mouthpiece. In this case, a fluid such as the vapor or theliquid discharged from the living tissue L_(T) is sucked from theconnection mouthpiece, whereby the fluid can easily be discharged fromthe fluid discharge ports 242 a, 244 a.

It is to be noted that the fluid discharge ports 242 a, 244 a arepreferably provided in the shaft 224, but may preferably be provided inthe handle 222 instead of the shaft 224.

The base portion 274 of the first holding member 262 is fixed to thedistal end of the cylindrical member 242 of the shaft 224. On the otherhand, the base portion 278 of the second holding member 264 is rotatablysupported on the distal end of the cylindrical member 242 of the shaft224 by a support pin 280 arranged in a direction crossing the axialdirection of the shaft 224 at right angles. The second holding member264 can rotate around the axis of the support pin 280 to open and closewith respect to the first holding member 262. The second holding member264 is urged by an elastic member 280 a such as a leaf spring so thatthe second holding member opens with respect to the first holding member262.

The outer surfaces of the main bodies 272, 276 of these first and secondholding members 262, 264 are formed into a smoothly curved shape.Similarly, the outer surfaces of the base portions 274, 278 of thesefirst and second holding members 262, 264 are also formed into asmoothly curved shape. In a state in which the second holding member 264is closed with respect to the first holding member 262, the sections ofthe main bodies 272, 276 of the respective holding members 262, 264 areformed into a substantially circular or elliptic shape. In a state inwhich the second holding member 264 is closed with respect to the firstholding member 262, the holding faces 272 b, 276 b of the main bodies272, 276 of the first and second holding members 262, 264 face eachother, and the base portions 274, 278 are formed into a cylindricalshape. In this state, the diameter of the proximal ends of the mainbodies 272, 276 of the first and second holding members 262, 264 isformed to be larger than the diameter of the base portions 274, 278.Then, stepped portions 282 a, 282 b are formed between the main bodies272, 276 and the base portions 274, 278, respectively.

Here, with regard to the first holding member 262 and the second holdingmember 264, in a state in which the second holding member 264 is closedwith respect to the first holding member 262, the outer peripheralsurface of the substantially circular or elliptic shape obtained bycombining the base portions 274, 278 of the holding members is formed assubstantially the same plane as the outer peripheral surface of thedistal end of the cylindrical member 242 or formed with a diameterslightly larger than that of the outer peripheral surface. Inconsequence, the sheath 244 is slid with respect to the cylindricalmember 242, whereby the distal end of the sheath 244 can cover the baseportions 274, 278 of the first holding member 262 and the second holdingmember 264. In this state, as shown in FIG. 10A, the first holdingmember 262 and the second holding member 264 close against the urgingforce of the elastic member 280 a. On the other hand, in a case wherethe sheath 244 is slid toward the proximal end of the cylindrical member242 from a state in which the distal end of the sheath 244 covers thebase portions 274, 278 of the first holding member 262 and the secondholding member 264, as shown in FIG. 10B, the second holding member 264opens with respect to the first holding member 262 owing to the urgingforce of the elastic member 280 a.

Moreover, in this embodiment, a space between the proximal ends of thefirst high-frequency electrode 266 and a space between the proximal endsof the second high-frequency electrode 270 are formed to beapproximately equal to the sizes of the widths of the cutter guidegrooves 262 a, 264 a of the first holding member 262 and the secondholding member 264, respectively (see FIG. 12). However, the spacebetween the proximal ends of the first high-frequency electrode 266 andthe space between the proximal ends of the second high-frequencyelectrode 270 may appropriately be set, respectively. That is, the firstand second high-frequency electrodes 266, 270 may be provided away fromthe edges of the cutter guide grooves 262 a, 264 a of the first holdingmember 262 and the second holding member 264.

As shown in FIG. 13, in the energy source 214, a control section 290, ahigh-frequency energy output circuit 292, a heat generation elementdriving circuit 294, a display section 296 and a speaker 298 arearranged. The control section 290 is connected to the high-frequencyenergy output circuit 292, the heat generation element driving circuit294, the display section 296 and the speaker 298, and the controlsection 290 controls these components. Then, the high-frequency energydriving circuit 292 is connected to the heat generation element drivingcircuit 294 via the control section 290. The control section 290 isconnected to the foot switch 216. When the foot switch 216 is turned on,the energy treatment instrument 212 performs a treatment. When theswitch is turned off, the treatment stops. The display section 296functions as setting means of the control section 290.

It is to be noted that although not shown, the high-frequency energyoutput circuit (a high-frequency energy output section) 292 outputs thehigh-frequency energy, and can detect an impedance Z as described in thefirst embodiment (see FIG. 2). That is, the high-frequency energy outputcircuit 292 has a sensor function for measuring the impedance Z of theliving tissue L_(T) between the first high-frequency electrode 266 andthe second high-frequency electrode 270 of the energy treatmentinstrument 212.

Moreover, although not shown here (see FIG. 2), the heat generationelement driving circuit 294 supplies the energy to the heater member 268to allow the heater member 268 to generate the heat, and the circuit 294has a sensor function for measuring a heat generation temperature T ofthe heater member 268.

Next, the operation of the treatment system 210 according to thisembodiment will be described.

An operator operates the display section 296 of the energy source 214 inadvance to set the output conditions of the treatment system 210.Specifically, a set power Pset [W] of high-frequency energy output, aset temperature Tset [° C.] of heat energy output, threshold values Z1,Z2 of the impedance Z of the living tissue L_(T) and the like are set.

As shown in FIG. 10A, in a state in which the second holding member 264is closed with respect to the first holding member 262, the holdingsection 226 and the shaft 224 of the surgical treatment instrument 212are inserted into, for example, an abdominal cavity through an abdominalwall. The holding section 226 of the surgical treatment instrument 212is opposed to the living tissue L_(T) as a treatment target. To hold theliving tissue L_(T) as the treatment target between the first holdingmember 262 and the second holding member 264, the holding sectionopening/closing knob 232 of the handle 222 is operated. At this time,with respect to the cylindrical member 242, the sheath 244 is moved tothe proximal end of the shaft 224. A cylindrical portion between thebase portions 274 and 278 cannot be maintained owing to the urging forceof the elastic member 280 a, whereby the second holding member 264 openswith respect to the first holding member 262.

The living tissue L_(T) as the treatment target is arranged between thefirst high-frequency electrode 266 of the first holding member 262 andthe second high-frequency electrode 270 of the second holding member264. In this state, the grasping section opening/closing knob 232 of thehandle 222 is operated. At this time, with respect to the cylindricalmember 242, the sheath 244 is moved to the distal end of the shaft 224.The base portions 274, 278 are closed against the urging force of theelastic member 280 a by the sheath 244 to form the cylindrical portionbetween the base portions. In consequence, the main body 272 of thefirst holding member 262 formed integrally with the base portion 274 andthe main body 276 of the second holding member 264 formed integrallywith the base portion 278 close. That is, the second holding member 264closes with respect to the first holding member 262. Thus, the livingtissue L_(T) as the treatment target is grasped between the firstholding member 262 and the second holding member 264.

At this time, the living tissue L_(T) as the treatment target comes incontact with both the first high-frequency electrode 266 provided on thefirst holding member 262 and the second high-frequency electrode 270provided on the second holding member 264. The peripheral tissue of theliving tissue L_(T) as the treatment target comes in close contact withboth the facing contact faces of the edge of the holding face 272 b ofthe first holding member 262 and the edge (not shown) of the holdingface 276 b of the second holding member 264.

FIG. 14 shows one example of the control flow of the surgical treatmentinstrument 212 controlled by the high-frequency energy output circuit292 and the heat generation element driving circuit 294.

The foot switch 216 is operated in a state in which the living tissue isgrasped between the first holding member 262 and the second holdingmember 264. The control section 290 of the energy source 214 judgeswhether or not the switch 216 is turned on by operator's operation (STEP41). When the foot switch 216 is turned on, the high-frequency energyoutput circuit 292 of the energy source 214 supplies the energy to theliving tissue L_(T) between the first high-frequency electrode 266 andthe second high-frequency electrode 270 via the cable 228 (STEP 42).Then, the set power Pset [W] preset in the display section 296, forexample, a power of about 20 [W] to 80 [W] is supplied between theelectrodes 266 and 270 of the first and second holding members 262, 264.

In consequence, a high-frequency current flows through the living tissueL_(T) grasped between the first holding member 262 and the secondholding member 264, and the living tissue L_(T) is allowed to generateheat to start the cauterizing of the tissue (the denaturing of thetissue). At this time, the impedance Z of the grasped living tissueL_(T) is measured by the high-frequency energy output circuit 292. Theimpedance Z at a time of treatment start is, for example, about 60[Ω] asshown in FIG. 15. Subsequently, when the high-frequency current flowsthrough the living tissue L_(T) to cauterize the living tissue L_(T),the value of the impedance Z rises.

When the living tissue L_(T) is cauterized in this manner, a fluid(e.g., a liquid (blood) and/or the gas (water vapor)) is discharged fromthe living tissue L_(T). At this time, the holding faces 272 b, 276 b ofthe first and second holding members 262, 264 come in closer contactwith the living tissue L_(T) than the electrodes 266, 270. Therefore,the holding faces 272 b, 276 b function as a barrier portion (a dam)which inhibits the fluid from being released from the first and secondholding members 262, 264. Therefore, the fluid discharged from theliving tissue L_(T) is allowed to flow into the cutter guide grooves 262a, 264 a disposed internally from the electrodes 266, 270, and the fluidis sucked to flow from the first and second holding members 262, 264 tothe shaft 224. While the fluid is discharged from the living tissueL_(T), the fluid is allowed to continuously flow into the cutter guidegrooves 262 a, 264 a. In consequence, it is prevented that thermalspread is caused by the fluid discharged from the living tissue L_(T) ina state in which the temperature rises, and it can be prevented that aportion which is not the treatment target is influenced.

Subsequently, the control section 290 judges whether the impedance Zduring the high-frequency energy output calculated based on the signalfrom the high-frequency energy output circuit 292 is the presetthreshold value Z1 (here, about 1000[Ω] as shown in FIG. 15) or more(STEP 43). The threshold value Z1 is in such a position that the riseratio of the value of the impedance Z known in advance becomes dull.Then, in a case where it is judged that the impedance Z is smaller thanthe threshold value Z1, processing is returned to STEP 42. That is, thehigh-frequency energy for the treatment is continuously applied to theliving tissue L_(T) grasped between the electrodes 266 and 270 of thefirst and second holding members 262, 264.

In a case where it is judged that the impedance Z becomes larger thanthe threshold value Z1, the control section 290 transmits a signal tothe heat generation element driving circuit 294. Then, the heatgeneration element driving circuit 294 supplies a power to the heatermember 268 so that the temperature of the heater member 268 is a presettemperature Tset [° C.], for example, a temperature of 100 [° C.] to 300[° C.] (STEP 44). In consequence, the living tissue L_(T) graspedbetween the electrodes 266 and 270 of the first and second holdingmembers 262, 264 conducts the heat to the first electrode 266 owing tothe heat conducted from the heater member 268, and the heat coagulatesthe living tissue L_(T) internally from the side of the front surface ofthe living tissue L_(T) which comes in close contact with the firstelectrode 266.

Subsequently, the control section 290 judges whether the impedance Z ofthe living tissue L_(T) monitored by the high-frequency energy outputcircuit 292 is a preset threshold value Z2 (here, about 2000[Ω] as shownin FIG. 15) or more (STEP 45). In a case where it is judged that theimpedance Z is smaller than the threshold value Z2, the processing isreturned to STEP 44. On the other hand, in a case where it is judgedthat the impedance Z is the threshold value Z2 or more, the controlsection 290 issues a buzzer sound from the speaker 298 (STEP 46), andstops the output of high-frequency energy and heat energy (STEP 47). Inconsequence, the treatment of the living tissue L_(T) by use of thetreatment system 210 is completed.

As described above, according to this embodiment, the following effectis obtained. The description of the effect described in the firstembodiment is omitted.

The fluid (a water content, vapor) generated at a time when thehigh-frequency energy is applied to the living tissue L_(T) to destroythe cell membrane of the living tissue L_(T) and/or a time when the heatenergy is applied to cauterize the living tissue L_(T) can be guided tothe cutter guide grooves 262 a, 264 a. The fluid is guided to thesecutter guide grooves 262 a, 264 a, whereby the fluid generated from theliving tissue L_(T) can be discharged from the shaft 224 or the handle222 through the energy treatment instrument 212. In consequence, it canbe prevented that the heat is applied to a living tissue L_(T) which isnot related to the treatment owing to the fluid generated from thetreated living tissue L_(T). That is, the fluid can be guided from theliving tissue L_(T) to these cutter guide grooves 262 a, 264 a toprevent the thermal spread from being caused.

It is to be noted that in the second embodiment, the structure has beendescribed in which to prevent the thermal spread, the holding faces 272b, 276 b disposed externally from the first high-frequency electrode 266are used as the barrier portion. In addition, a structure is preferablein which the holding faces 272 b, 276 b of the second embodiment areprovided with, for example, a cooling plate for cooling via a coolingmedium or the like, whereby the living tissue L_(T) and a fluid such asthe vapor can indirectly be cooled.

Moreover, in this embodiment, the linear energy treatment instrument 212(see FIG. 9) for treating the living tissue L_(T) in the abdominalcavity (in the body) through the abdominal wall has been described asthe example, but as shown in, for example, FIG. 16, an open type linearenergy treatment instrument (a treatment instrument) 212 a for taking atreatment target tissue from the body through the abdominal wall totreat the tissue may be used.

The energy treatment instrument 212 a includes a handle 222 and aholding section 226. That is, unlike the energy treatment instrument 212(see FIG. 9) for treating the tissue through the abdominal wall, a shaft224 is omitted. On the other hand, a member having a function similar tothat of the shaft 224 is arranged in the handle 222. In consequence, theenergy treatment instrument 212 a shown in FIG. 16 can be used in thesame manner as in the energy treatment instrument 212 described abovewith reference to FIG. 9.

First Modification of Second Embodiment

Next, a first modification will be described with reference to FIGS. 17Aand 17E. This modification is the modification of the second embodiment,and the description of the same members as those described in the secondembodiment or members producing the same function as that of the secondembodiment is omitted. This hereinafter applies to second to fifthmodifications.

In this modification, the output configuration of energy generated froma high-frequency energy output circuit 292 and a heat generation elementdriving circuit 294 will be described.

In the example shown in FIG. 17A, unlike the example of the secondembodiment shown in FIG. 15, the high-frequency energy output circuit292 outputs energy, and an impedance Z of a living tissue L_(T) reachesa threshold value Z1. Afterward, the high-frequency energy is outputevery predetermined time to measure the impedance Z of the living tissueL_(T) every time.

On the other hand, when the impedance Z reaches the threshold value Z1,the heat generation element driving circuit 294 simultaneously outputsenergy to a heater member 268, and heat (heat energy) is conducted fromthe heater member 268 to the living tissue L_(T) via an electrode 266 totreat the tissue L_(T).

Subsequently, when the impedance Z reaches a threshold value Z2, theoutput from the high-frequency energy output circuit 292 and heatgeneration element driving circuit 294 is automatically stopped toautomatically end the treatment.

In the example shown in FIG. 17B, the high-frequency energy outputcircuit 292 outputs the energy, and the impedance Z of the living tissueL_(T) reaches the threshold value Z1. Afterward, the high-frequencyenergy is output as monitor output to continuously measure the change ofthe impedance Z.

On the other hand, the high-frequency energy output circuit 292 outputsthe energy to the heater member 268, and the heat generation elementdriving circuit 294 simultaneously outputs the energy to the heatermember 268. The output at this time is monitor output for a purpose ofmeasuring the temperature of the living tissue L_(T). Subsequently, whenthe impedance Z reaches the threshold value Z1, the heat generationelement driving circuit 294 simultaneously outputs the energy for thetreatment to the heater member 268, and the heater member 268 is allowedto generate the heat. Then, the heat energy is conducted from the heatermember 268 to the living tissue L_(T) through the electrode 266 to treatthe tissue L_(T). At this time, the temperature of the living tissueL_(T) can also be measured.

Subsequently, when the impedance Z reaches the threshold value Z2, theoutput from the high-frequency energy output circuit 292 and heatgeneration element driving circuit 294 is automatically stopped toautomatically end the treatment.

In the example shown in FIG. 17C, the high-frequency energy outputcircuit 292 outputs the energy, and the impedance Z of the living tissueL_(T) reaches the threshold value Z1. Afterward, the high-frequencyenergy is output as the monitor output to continuously measure thechange of the impedance Z.

On the other hand, it is predicted that the impedance Z reaches thethreshold value Z1. Immediately before the impedance reaches thethreshold value Z1, the energy is output from the heat generationelement driving circuit 294 to the heater member 268, and the heat isconducted from the heater member 268 to the living tissue L_(T) via theelectrode 266 to treat the tissue L_(T). At this time, the amount of theenergy to be supplied to the heater member 268 is gradually increased,and held in a constant state.

Subsequently, when the impedance Z reaches the threshold value Z2, theoutput from the high-frequency energy output circuit 292 and heatgeneration element driving circuit 294 is automatically stopped, and thetreatment is automatically ended.

The example shown in FIG. 17D is an example in which before the energyis output from the high-frequency energy output circuit 292, the energyis output from the heat generation element driving circuit 294 to theheater member 268 to keep the living tissue L_(T) as the treatmenttarget at such a temperature (T0) that protein denaturation is notcaused. The temperature of the living tissue L_(T) as the treatmenttarget is preliminarily kept in this manner, whereby the impedance Z canbe lowered and stabilized. Afterward, the above-mentioned appropriatetreatment is performed, so that the treatment of the living tissue L_(T)can be stabilized.

The example shown in FIG. 17E is an example in which the energy isdiscontinuously output from the heat generation element driving circuit294 to the heater member 268. The energy is once preliminarily appliedto the heater member 268 to output the energy from the member, beforethe impedance Z reaches the threshold value Z1. Afterward, when theimpedance Z reaches the threshold value Z1 and then the heat generationelement driving circuit 294 applies the energy to the heater member 268,the temperature of the heater member 268 can immediately be raised to adesired temperature.

Second Modification of Second Embodiment

Next, a second modification will be described with reference to FIG. 18.In this modification, another preferable configuration of a heatermember 268 provided on a first holding member 262 will be described.

As shown in FIG. 18, the back surface of a first high-frequencyelectrode 266 arranged on a main body 272 of the first holding member262 is provided with a heat generation resistor of a screen printedthick film, a heat generation resistor of a thin film formed by aphysical vapor deposition (PVD) process or a nichrome line. Inconsequence, for example, a U-shaped heater member 268 which does nothave any cut is fixed to the back surface of the U-shaped firsthigh-frequency electrode 266.

In consequence, when energy is applied to the heater member 268 and heatis generated from the heater member 268, the heat is conducted from theheater member 268 to the first high-frequency electrode 266.

The heater member 268 described in this modification is not limited tothe heat generation resistor of the thick or thin film or the nichromeline, and various heating elements may be used.

Third Modification of Second Embodiment

Next, a third modification will be described with reference to FIGS. 19Ato 20C. In this modification, the configuration of a first holdingmember 262 will be described. In this modification, the configuration ofa first high-frequency electrode 266 arranged on a main body 272 of thefirst holding member 262 will mainly be described, and a treatment usinga cutter 254 will also be described.

As shown in FIGS. 19A to 19C, the main body 272 of the first holdingmember 262 is provided with the first high-frequency electrode 266. Asshown in FIG. 19A, the first high-frequency electrode 266 includes acontinuous electrode (a sealing member, a first bonding member) 302formed continuously without any cut, and a plurality of discreteelectrodes (maintaining members, second bonding members) 304 arrangedoutside this continuous electrode 302 in a discrete manner.

The continuous electrode 302 is continuously formed into, for example, asubstantial U-shape so that the continuous electrode 302 has two ends inthe proximal end of the main body 272 of the first holding member 262. Aspace between the proximal ends of the continuous electrode 302 isapproximately the width of a cutter guide groove 262 a (see FIGS. 19Aand 19C), but the space between the proximal ends of the continuouselectrode 302 can appropriately be set. That is, the continuouselectrode 302 may be provided away from the edge of the cutter guidegroove 262 a of the first holding member 262.

A plurality of discrete electrodes 304 having the same shape arearranged at substantially equal intervals along a substantially U-shapedvirtual track. The discrete electrodes 304 are formed into, for example,a circular shape. The discrete electrodes 304 are arranged so that asubstantially predetermined space is made between the electrodes 304,and the respective discrete electrodes 304 are arranged as much as anappropriate distance away from the continuous electrode 302. Thediscrete electrodes 304 are positioned so that when a treatment isperformed, the living tissue L_(T) between the discrete electrode 304and a discrete electrode (not shown) of the second holding member 264 isallowed to denature owing to the heat, but the denaturation of theliving tissue L_(T) between the discrete electrodes 304 of the firstholding member 262 due to the heat and the denaturation of the livingtissue between the discrete electrodes 304 and the continuous electrode302 due to the heat are prevented as much as possible.

It is to be noted that the heater members 268 are preferably fixed toboth of the continuous electrode 302 and the discrete electrodes 304 ofthe first holding member 262. Therefore, the non-uniformity of the heatconduction from the heater members 268 to the continuous electrode 302and the discrete electrodes 304 can be prevented as much as possible,and the heat can be applied to the living tissue L_(T) as uniformly aspossible.

The main body 272 and the base portion 274 of the first holding member262 are provided with the cutter guide groove 262 a for guiding thecutter 254 therethrough. A main body 276 and a base portion 278 of thesecond holding member 264 are provided with a cutter guide groove 264 afor guiding the cutter 254 therethrough. These cutter guide grooves 262a, 264 a are formed along the axial direction of a shaft 224. Therefore,the cutter 254 can move along the cutter guide grooves 262 a, 264 a inthe first holding member 262 and the second holding member 264.

As described in the second embodiment and the second modification of thesecond embodiment, the heater member 268 is arranged discretely and/orcontinuously on the back surface of the continuous electrode 302 and/orthe discrete electrode 304.

Moreover, the second holding member 264 is also provided with the secondhigh-frequency electrode 270 symmetrically with the first holding member262. The detailed description of this respect is omitted.

It is to be noted that although not shown, the continuous electrode ofthe second high-frequency electrode 270 is conveniently denoted withreference numeral 306, and the discrete electrodes are denoted withreference numeral 308 in the following description of a function.

Next, the function of the treatment system 210 according to thismodification will be described.

As shown in FIG. 10A, in a state in which the second holding member 264is closed with respect to the first holding member 262, for example, theholding section 226 and the shaft 224 of the energy treatment instrument212 are inserted into, for example, an abdominal cavity through anabdominal wall. Then, the living tissue L_(T) as the treatment target isheld between the first holding member 262 and the second holding member264.

At this time, the living tissue L_(T) as the treatment target comes incontact with both of the first high-frequency electrode 266 provided onthe first holding member 262 and the second high-frequency electrode 270provided on the second holding member 264. The peripheral tissue of theliving tissue L_(T) as the treatment target comes in close contact withboth of the holding face 272 b of the main body 272 of the first holdingmember 262 and the holding face 276 b of the main body 276 of the secondholding member 264.

When the pedal 216 a of the foot switch 216 is operated in this state,energy is supplied to the first high-frequency electrode 266 and thesecond high-frequency electrode 270.

The first high-frequency electrode 266 supplies a high-frequency currentbetween the electrode and the second high-frequency electrode 270 viathe living tissue L_(T) as the treatment target. In consequence, theliving tissue L_(T) between the first high-frequency electrode 266 andthe second high-frequency electrode 270 is heated. In this case, theliving tissue L_(T) is continuously (a substantially U-shaped state)denatured by the continuous electrodes 302, 306 of the first and secondhigh-frequency electrodes 266, 270. Furthermore, the living tissue L_(T)between these discrete electrodes 304 and 308 is discretely denatured bythe discrete electrodes 304, 308 of the first and second high-frequencyelectrodes 266, 270.

When the pressed pedal 216 a of the foot switch 216 is maintained andthe impedance Z reaches the threshold value Z1, the amount of thehigh-frequency energy to be supplied is reduced to switch to the monitoroutput, and the energy is supplied to the heater member 268 to allow theheater member 268 to generate the heat. Therefore, the heat energy ofthe heater member 268 is conducted from the heater member to thecontinuous electrode 302 and the discrete electrodes 304. Then, theliving tissue L_(T) receives the heat from the front surfaces of thecontinuous electrode 302 and the discrete electrodes 304, and iscauterized. Subsequently, when the impedance Z reaches the thresholdvalue Z2, the supply of the high-frequency energy and heat energy isstopped. That is, when the pedal 216 a of the foot switch 216 iscontinuously pressed and the impedance Z reaches the threshold value Z2,the treatment automatically ends.

Here, there will be described a case where, for example, intestinalcanals I_(C1), I_(C2) of a small intestine are anastomosed with eachother by use of the treatment system 210 having such a function as shownin FIGS. 20A to 20C.

The holding faces 272 b, 276 b of the first and second holding members262, 264 hold a pair of arranged intestinal canals I_(C1), I_(C2)between the wall surfaces of both the intestinal canals I_(C1), I_(C2).When the pedal 216 a of the foot switch 216 is pressed in this state,the energy is supplied to the first and second high-frequency electrodes266, 270, respectively. Then, the intestinal canals I_(C1), I_(C2) heldbetween the continuous electrode 302 of the first holding member 262 andthe continuous electrode 306 of the second holding member 264 are heatedand denatured. In consequence, the wall surfaces of the intestinalcanals I_(C1), I_(C2) are continuously denatured.

Moreover, simultaneously with the denaturation of the living tissue bythe continuous electrodes 302, 306, the intestinal canals I_(C1), I_(C2)between the discrete electrodes 304 of the first holding member 262 andthe discrete electrodes 308 of the second holding member 264 aredenatured. In consequence, the wall surfaces of the intestinal canalsI_(C1), I_(C2) are discretely denatured.

Afterward, when the impedance Z reaches the threshold value Z1, theamount of the high-frequency energy to be supplied is reduced to switchto the monitor output, and the energy is supplied to the heater member268 to generate the heat from the heater member 268. In consequence, theheat is conducted from the heater member 268 to the continuous electrode302 and the discrete electrodes 304 owing to the heat energy generatedfrom the heater member 268, and the heat is conducted to the intestinalcanals I_(C1), I_(C2) to bond the wall surfaces to each other.Subsequently, when the impedance Z reaches the threshold value Z2, thesupply of the energy automatically stops, thereby ending the treatment.

Thus, the living tissues of the intestinal canals I_(C1), I_(C2) arediscretely denatured and bonded to each other.

Then, the supply of the energy to the first and second high-frequencyelectrodes 266, 270 and the heater member 268 is stopped. Afterward,while the intestinal canals I_(C1), I_(C2) are grasped, the cutterdriving knob 234 shown in FIG. 9 is operated to move forwards the cutter254 along the cutter guide grooves 262 a, 264 a from the state shown inFIGS. 10A and 10B. When the cutter 254 moves forwards, a portiondenatured and bonded by the continuous electrodes 302, 306 is cut. Then,the cutter 254 cuts the inner portion of the substantially U-shapeddenatured portion is cut to the vicinity of the distal end of theportion with the continuous electrodes 302, 306. Therefore, a portionbetween the substantially U-shaped sealed portions of the wall surfacesof the intestinal canals I_(C1), I_(C2) is cut to connect the wallsurfaces of the intestinal canals I_(C1), I_(C2) to each other. That is,the wall surfaces of the intestinal canals I_(C1), I_(C2) areanastomosed with each other.

The holding section opening/closing knob 232 of the handle 222 isoperated in this state to open the first and second holding members 262,264. At this time, a first anastomosed portion A_(N1) on a mesenterium Mside and a second anastomosed portion A_(N2) on a side opposite to aside provided with the mesenterium M are formed. As shown in, forexample, FIG. 20B, the continuously bonded outer portion of the secondanastomosed portion A_(N2) is discretely denatured.

Furthermore, in a state in which the first and second holding members262, 264 are closed to hold the ends of the intestinal canals I_(C1),I_(C2), the pedal 16 a of the foot switch 16 is pressed to apply thehigh-frequency energy and the heat energy. In consequence, as shown inFIG. 20C, the ends of the intestinal canals I_(C1), I_(C2) are denaturedand sealed by the high-frequency electrodes 266, 270 and the heatermember 268. That is, the ends of the intestinal canals I_(C1), I_(C2)are provided with a seal portion Sp. At this time, the section cut alongthe 20A-20A line of FIG. 20C schematically has the state shown in FIG.20A. In consequence, the intestinal canals I_(C1), I_(C2) having theends thereof sealed with the seal portion Sp are anastomosed with eachother.

It is to be noted that the extra portion of the seal portion Sp is cutwith, for example, the cutter 254. At this time, the continuously bondedperipheral portion of the sealed end (the seal portion Sp) of theintestinal canals I_(C1), I_(C2) is discretely denatured in the samemanner as in FIG. 20B. That is, the living tissue between the portionsof the intestinal canals I_(C1), I_(C2) denatured and bonded by thediscrete electrodes 304, 308 is not denatured. Therefore, the periphery(the vicinity) of the portion of the living tissue bonded by thediscrete electrodes 304, 308 comes in contact with (comes in closecontact with) the living tissue of the intestinal canals I_(C1), I_(C2)which are not denatured.

Therefore, at the first anastomosed portion A_(N1) on the mesenterium Mside, a force is exerted in a direction in which the intestinal canalsI_(C1), I_(C2) come in close contact with each other. Then, the portionwhere the living tissue has been denatured by the discrete electrodes304, 308 exerts such a force that the living tissues more firmly come inclose contact with each other. Furthermore, at the second anastomosedportion A_(N2) on the side opposite to the side provided with themesenterium M, a force F₁ is exerted in a direction in which theintestinal canals I_(C1), I_(C2) open, but the portion in which theliving tissue has been denatured by the discrete electrodes 304, 308exerts such a force that the living tissues come in close contact witheach other. Therefore, the mutual network of the living tissues of theintestinal canals I_(C1), I_(C2) which are not denatured is generated,and the tissue regenerative force of the living tissue is exerted,whereby the living tissues of the intestinal canals I_(C1), I_(C2) areregenerated earlier.

As described above, according to this modification, the following effectis obtained.

The continuous electrodes 302, 306 and the discrete electrodes 304, 308are arranged on the holding faces 272 b, 276 b of the first and secondholding members 262, 264, respectively. Then, the living tissue (e.g.,the intestinal canals I_(C1), I_(C2)) between the continuous electrode302 of the first holding member 262 and the continuous electrode 306 ofthe second holding member 264 can be heated, denatured and continuouslybonded. Therefore, for example, tubular living tissues can be broughtinto close contact with each other or sealed. Furthermore, the livingtissue (e.g., the intestinal canals I_(C1), I_(C2)) between the discreteelectrodes 304 of the first holding member 262 and the discreteelectrodes 308 of the second holding member 264 can be heated, denaturedand continuously bonded to each other. That is, the living tissues candiscretely be bonded to each other.

At this time, as shown in, for example, FIG. 20B, a portion in which theliving tissues are continuously denatured and bonded to each other ispositioned close to a portion in which the living tissues are discretelydenatured and bonded to each other. Then, a portion between the livingtissues around the portion in which the living tissues are discretelydenatured and bonded to each other is not denatured. In consequence, itis possible to maintain a state where the living tissues which are notdenatured around the discretely denatured and bonded portion are broughtinto (close) contact with each other. That is, the discrete electrodes304, 308 perform a great role in maintaining the close contact state ofthe living tissues to which the force F₁ having, for example, such adirection that the tissues come away from each other is applied.

In a case where, for example, two intestinal canals I_(C1), I_(C2) areanastomosed with each other, the force F₁ acts in a direction in whichthe intestinal canals I_(C1), I_(C2) come away from each other on theside opposite to the side provided with the mesenterium M shown in FIGS.20A and 20C. However, the intestinal canals I_(C1), I_(C2) arediscretely bonded to each other by the discrete electrodes 304, so thatthe intestinal canals I_(C1), I_(C2) can discretely be bonded to eachother. Therefore, the mutual close contact state of the intestinalcanals I_(C1), I_(C2) can be maintained.

Therefore, the portion between the living tissues bonded to each otherby the discrete electrodes 304, 308 performs a function of maintaining astate in which the living tissues are drawn to each other and broughtinto close contact with each other. That is, the portion between theliving tissues bonded to each other by the discrete electrodes 304, 308performs a function of maintaining the conglutination of the livingtissues. Therefore, the mutual network of the living tissues broughtinto close contact (conglutinated) with each other is generated, and thetissue regenerative force of the living tissue is more easily exerted,whereby the living tissue can be regenerated earlier.

It is to be noted that in this modification, it has been described thatthe discrete electrodes 304 of the first holding member 262 are arrangedat substantially equal intervals, and have a substantially equal area,but the space between the adjacent discrete electrodes 304 preferablyvaries, and the area of the discrete electrode 304 preferably varies.When the tissues are discretely treated by the discrete electrodes 304,the portions which come in contact with the discrete electrodes 304 aredenatured. However, the discrete electrodes 304 may variously bemodified as long as it is possible to maintain a state in which a partof the living tissue between the discrete electrodes 304 disposedadjacent to each other is not denatured and the living tissues arebrought into contact with each other. Needless to say, this also appliesto the discrete electrodes 308 of the second holding member 264.Moreover, the heater set temperature of the discrete electrode, theheater set temperature of the continuous electrode, output time andoutput timing may variously be combined so that a difference is givenbetween them.

It is to be noted that in this modification, a case where the cutter 254is provided has been described, but the cutter 254 does not have to beprovided, depending on the treatment target. In a case where the cutter254 is not provided, the above cutter guide grooves 262 a, 264 a canfunction as a fluid discharge groove (a channel) which guides a fluidsuch as vapor or a liquid generated from the living tissue to the handle222 of the energy treatment instrument 212.

Next, the modification of the discrete electrodes 304 is shown in FIG.19D. With regard to the discrete electrodes 304 of the first holdingmember 262 shown in FIG. 19A, an example has been described in which thediscrete electrodes are arranged at equal intervals along thesubstantially U-shaped virtual track disposed outside the substantiallyU-shaped continuous electrode 302. In addition, as shown in FIG. 19D,the discrete electrodes 304 are preferably arranged in zigzag vertexpositions. That is, the discrete electrodes 304 are preferably arrangedin two rows. In this case, the arrangement of the discrete electrodes304 and a distance between the electrodes are appropriately determinedin accordance with the magnitude of the output of the continuouselectrode 302, the area of the discrete electrode 304 itself withrespect to the living tissue and the like.

It is to be noted that the discrete electrodes 304 may be arranged atrandom, and various other changes are allowed. Moreover, the shape ofthe discrete electrode 304 may variously be changed to a rectangularshape, an elliptic shape, a rhombic shape, a polygonal shape or thelike.

As described above, according to this modification, the following effectis obtained.

The continuous electrodes 302, 306 and the discrete electrodes 304, 308are arranged on the holding faces 272 b, 276 b of the first and secondholding members 262, 264, respectively. Then, the living tissues (e.g.,the intestinal canals I_(C1), I_(C2)) between the continuous electrode302 of the first holding member 262 and the continuous electrode 302 ofthe second holding member 264 can be heated, denatured and continuouslybonded. Therefore, for example, tubular living tissues can be broughtinto close contact with each other and sealed. Furthermore, the livingtissues (e.g., the intestinal canals I_(C1), I_(C2)) between thediscrete electrodes 304 of the first holding member 262 and the discreteelectrodes 308 of the second holding member 264 can be heated anddenatured to bond the living tissues to each other. That is, the livingtissues can discretely be bonded to each other.

At this time, as shown in, for example, FIG. 20B, a portion in which theliving tissues are continuously denatured and bonded to each other ispositioned close to a portion in which the tissues are discretelydenatured and bonded to each other. Then, a portion between the livingtissues around the discretely denatured and bonded portion is notdenatured. Therefore, the living tissues which are not denatured aroundthe discretely denatured and bonded portion can be brought into (close)contact with each other. That is, the discrete electrodes 304, 308perform a great role in maintaining, for example, a state where theliving tissues to which the forces F₁ having a detaching direction areapplied are brought into close contact with each other.

In a case where, for example, two intestinal canals I_(C1), I_(C2) areanastomosed with each other, the forces F₁ act in a direction in whichthe intestinal canals I_(C1), I_(C2) come away from each other on theside opposite to the side provided with the mesenterium M as shown inFIGS. 20A and 20C. However, the intestinal canals I_(C1), I_(C2) arediscretely bonded to each other by the discrete electrodes 304, so thatthe intestinal canals I_(C1), I_(C2) can discretely be bonded to eachother. Therefore, the intestinal canals I_(C1), I_(C2) can be maintainedin a state in which the canals are brought into close contact with eachother.

Therefore, the portion of the living tissues bonded to each other by thediscrete electrodes 304, 308 performs a function of maintaining thestate in which the living tissues are drawn to each other and broughtinto close contact with each other. That is, the portion of the livingtissues bonded to each other by the discrete electrodes 304, 308performs a function of maintaining the conglutination of the tissues. Inconsequence, the mutual network of the living tissues brought intocontact (conglutinated) with each other is generated, the tissueregenerative force of the living tissue is more easily exerted, and theliving tissue can be regenerated earlier.

It is to be noted that in this modification, it has been described thatthe discrete electrodes 304 of the first holding member 262 are arrangedat substantially equal intervals, and have a substantially equal area,but it is preferable that the space between the adjacent discreteelectrodes 304 or the area of the discrete electrode 304 varies. In acase where the tissues are discretely treated by the discrete electrodes304, the portions which come in contact with the discrete electrodes 304are denatured, but the discrete electrodes 304 may variously be modifiedas long as it is possible to maintain a state in which a part of theliving tissue between the discrete electrodes 304 disposed adjacent toeach other is not denatured and the living tissues are brought intocontact with each other.

Fourth Modification of Second Embodiment

Next, a fourth modification will be described with reference to FIG.21A. In this modification, the configuration of a first high-frequencyelectrode 266 provided on a main body 272 of a first holding member 262will be described.

As shown in FIG. 21A, outside a substantially U-shaped continuouselectrode 302, a plurality of branched electrodes (a maintaining member,a second bonding member) 312 branched from the continuous electrode 302are integrally formed. These branched electrodes 312 extend in adirection crossing the axial direction of the continuous electrode 302at right angles. That is, in this modification, the branched electrodes312 are arranged instead of the discrete electrodes 304 described in thethird modification.

The respective branched electrodes 312 are formed with a substantiallyequal length and a substantially equal width. That is, the respectivebranched electrodes 312 extend as much as a substantially equal areafrom the continuous electrode 302. A space between the branchedelectrodes 312 is a substantially equal space.

It is to be noted that the branched electrodes 312 denature a livingtissue L_(T) which comes in contact with the branched electrodes 312,but the electrodes 312 emit output to such an extent that thedenaturation of the living tissue L_(T) between the adjacent branchedelectrodes 312 is prevented. Such output depends on energy input from ahigh-frequency energy output circuit 292 or a heat generation elementdriving circuit 294 to the branched electrodes 312, additionally thespace between the branched electrodes 312, the width of the branchedelectrode 312 itself and the like.

The function and effect of a treatment system 210 according to thismodification are similar to those described in the second embodiment andthe third modification of the second embodiment, and hence thedescription thereof is omitted.

It is to be noted that the length and width (thickness) of each branchedelectrode 312, further the space between the branched electrodes 312 andthe number of the branched electrodes 312 are appropriately set. In FIG.21A, it is depicted that the thickness of the continuous electrode 302is larger than that of the branched electrode 312, but the thickness maybe equal, and the thickness of the branched electrode 312 may be larger.

With regard to the branched electrodes 312, for example, modificationsshown in FIGS. 21B and 21C are allowed. The modification of the branchedelectrodes 312 will be described with reference to FIG. 21B.

As shown in FIG. 21B, branched electrodes (a maintaining member, asecond bonding member) 314 on the most distal end (a side away from abase portion 274) of a main body 272 of a first holding member 262 aredeformed with respect to the branched electrodes 312 on the most distalend of the main body 272 of the first holding member 262 shown in FIG.21A. That is, the branched electrodes 314 shown in FIG. 21B are formedto be long as compared with the branched electrodes 312 on the mostdistal end of the main body 272 of the first holding member 262 shown inFIG. 21A.

Moreover, the branched electrodes 312 on the most distal end shown inFIG. 21A extend only in one direction (straight). On the other hand, theextending angle of each of the branched electrodes 314 shown in FIG. 21Bhalfway changes (the electrode is halfway bent). This is because abonding force to bond intestinal canals I_(C1), I_(C2) to each other isincreased to prevent the release of the anastomosing of the canals, in acase where when the intestinal canals I_(C1), I_(C2) are anastomosed asshown in, for example, FIG. 20C, forces F₂ act so that the anastomosingof the intestinal canals I_(C1), I_(C2) is released from the distal endof a portion denatured by a continuous electrode 302, that is, a portionB_(i) where the intestinal canals I_(C1), I_(C2) are branched.

The respective branched electrodes 314 shown in FIG. 21B extend in atleast two directions. Each of these branched electrodes 314 includes afirst portion 314 a formed integrally with the continuous electrode 302and extended in a direction crossing a substantially U-shaped virtualtrack of the continuous electrode 302 at right angles, and a secondportion 314 b formed integrally with the first portion 314 a andextended further from the first portion 314 a. The second portion 314 bof these portions extend in parallel with the branched electrodes 312.Then, in such a constitution, the branched electrode 314 has the firstportion 314 a and the second portion 314 b, whereby a bonding areacorresponding to the forces F₂ generated in the branched portion B₁ canbe increased. That is, owing to the first portion 314 a and the secondportion 314 b, the intestinal canals I_(C1), I_(C2) bonded to each otherdo not easily peel.

Therefore, a resistance to the forces F₂ applied to the intestinalcanals I_(C1), I_(C2) can be increased, so that a state in which theanastomosing of the intestinal canals I_(C1), I_(C2) is not easilyreleased can be obtained.

Next, a further modification of the branched electrodes 312 will bedescribed with reference to FIG. 21C.

As shown in FIG. 21C, branched electrodes (a maintaining member, asecond bonding member) 316 of a first holding member 262 are deformedwith respect to the branched electrodes 312 of the first holding member262 shown in FIG. 21A. The branched electrodes 316 are arranged in anoblique direction, instead of a direction crossing the axial directionof a continuous electrode 302 (a substantially U-shaped virtual track)of the continuous electrode 302. In this modification, the branchedelectrodes 316 extend toward, for example, a proximal end.

Therefore, as shown in FIG. 20D, in intestinal canals I_(C1), I_(C2),there are a portion bonded by the continuous electrode 302 and portionsbonded by the branched electrodes 316 with an appropriate angle withrespect to the longitudinal direction of the portion bonded by thecontinuous electrode 302. These branched electrodes 316 are formed to belong as compared with the branched electrodes 312 shown in FIG. 21A.Moreover, the portions bonded by the branched electrodes 316 aredisposed obliquely with respect to the direction of forces F₁ applied tothe intestinal canals I_(C1), I_(C2). Therefore, with regard to thebranched electrodes 316, a bonding area corresponding to the forces F₁having a direction to release anastomosing increases, so that a state inwhich the anastomosing of the intestinal canals I_(C1), I_(C2) is noteasily released can be obtained. Therefore, the branched electrodes 316having an appropriate angle with respect to the longitudinal directionof the portion connected to the continuous electrode 302 can have anincreased bonding force to bond the intestinal canals I_(C1), I_(C2) toeach other.

It is to be noted that as shown in FIG. 21C, branched electrodes (amaintaining member, a second bonding member) 318 on the most distal endof the first holding member 262 are deformed with respect to thebranched electrodes 312, 314 on the most distal end of the first holdingmember 262 shown in FIGS. 21A and 21B. That is, these branchedelectrodes 318 of this modification are formed to be long as comparedwith the branched electrodes 312, 314 on the most distal end of thefirst holding member 262 shown in FIGS. 21A and 21B.

Furthermore, the branched electrodes 318 shown in FIG. 21C arecircularly extended. Therefore, the branched electrodes 318 are extendedin a direction different from that of the branched electrodes 316. Insuch branched electrodes 318 provided on the distal end of the firstholding member 262, a resistance is increased against a time when forcesF₂ are generated in a portion B_(i) as shown in FIG. 21C, in a casewhere the intestinal canals I_(C1), I_(C2) are anastomosed areanastomosed. In consequence, the intestinal canals I_(C1), I_(C2) do noteasily peel from each other.

This is because the bonding force to bond the intestinal canals I_(C1),I_(C2) to each other is increased to prevent the release of theanastomosing, in a case where, for example, when the intestinal canalsI_(C1), I_(C2) are anastomosed, the forces F₂ act so that theanastomosing of the intestinal canals I_(C1), I_(C2) with each other isreleased from the distal end of a portion denatured by the continuouselectrode 302, that is, the portion B_(i) where the intestinal canalsI_(C1), I_(C2) are branched from each other.

It is to be noted that in this modification, the branched electrodes 314each having the first portion 314 a and the second portion 314 b and thebranched electrodes 318 have been described as the branched electrodesdisposed on the most distal end of the main body 272 of the firstholding member 262 in a case where the area of the bonding portioncorresponding to the forces F₂ is increased. However, the shapes of thebranched electrodes disposed on the most distal end of the main body 272of the first holding member 262 are not limited to these branchedelectrodes 314, 318, as long as the area of the bonding portioncorresponding to the forces F₂ increases.

Fifth Modification of Second Embodiment

Next, a fifth modification will be described with reference to FIGS. 22Ato 22C. In this modification, the configuration of a firsthigh-frequency electrode 266 provided on a main body 272 of a firstholding member 262 will be described.

As shown in FIG. 22A, the first high-frequency electrode 266 (acontinuous electrode 302 and discrete electrodes 304) is arranged atsubstantially the same position as that in the third modification shownin FIG. 19A. Moreover, a heater member 268 is also arranged atsubstantially the same position as that in the third modification shownin FIG. 19A.

As shown in FIGS. 22A and 22B, the main body 272 is provided with afirst fluid discharge groove (a fluid discharge groove for thecontinuous electrode) 332 as the channel of a fluid such as vapor or ahigh-temperature liquid outside the continuous electrode 302. The mainbody 272 is provided with second fluid discharge grooves (fluiddischarge grooves for the discrete electrodes) 334 as the channels of afluid such as the vapor or the high-temperature liquid in the outerperipheries of the discrete electrodes 304. These first and second fluiddischarge grooves 332, 334 are connected to each other via communicationpaths 336. The communication paths 336 are formed as conduits. That is,the respective communication paths 336 are formed in the main body 272.Then, the respective communication paths 336 are connected to a cutterguide groove 262 a in a base portion 274. That is, the first and secondfluid discharge grooves 332, 334 are connected to the cutter guidegroove 262 a in the base portion 274.

In the main body 272 of the first holding member 262, a barrier portion(a dam) 342 for the continuous electrode 302 is formed outside the firstfluid discharge groove 332 so that a fluid such as the vapor or thehigh-temperature liquid discharged owing to the function (including thefunction of the heater member 268) of the continuous electrode 302 flowsinto the first fluid discharge groove 332. In the main body 272, barrierportions 344 for the discrete electrodes 304 are formed in the outerperipheries of the second fluid discharge grooves 334 so that a fluidsuch as the vapor or the high-temperature liquid discharged owing to thefunction (including the function of the heater member 268) of thediscrete electrodes 304 flows into the second fluid discharge grooves334. As shown in FIG. 22B, these barrier portions 342, 344 are protrudedfrom the plane a holding face 272 b of the main body.

It is to be noted that similarly in a second holding member 264, a fluiddischarge groove (conveniently denoted with reference numeral 352) isformed outside a continuous electrode 306, and a barrier portion(conveniently denoted with reference numeral 362) is formed outside thefluid discharge groove 352. Moreover, fluid discharge grooves(conveniently denoted with reference numeral 354) are formed in theouter peripheries of discrete electrodes 308 of the second holdingmember 264, and barrier portions (conveniently denoted with referencenumeral 364) are formed in the outer peripheries of the fluid dischargegrooves 354. Then, the fluid discharge groove 352 outside the continuouselectrode 306 is connected to the fluid discharge grooves 354 in theouter peripheries of the discrete electrodes 308 via a communicationpath (conveniently denoted with reference numeral 356).

Next, the function of a treatment system 210 according to thismodification will be described.

As described in the second embodiment, a living tissue L_(T) as atreatment target is held between the first holding member 262 and thesecond holding member 264. At this time, the barrier portions 342, 344of the main body 272 of the first holding member 262 and the barrierportions 362, 364 of a main body 276 of the second holding member 264come in close contact with the living tissue L_(T), and the livingtissue L_(T) comes in contact with the first high-frequency electrode266 and a second high-frequency electrode 270.

In this state, a pedal 216 a of a foot switch 216 is operated. Energy issupplied from an energy source 214 to the first high-frequency electrode266 and the second high-frequency electrode 270, respectively. Then, theliving tissue L_(T) between the first high-frequency electrode 266 andthe second high-frequency electrode 270 is heated by high-frequencyenergy and heat energy. At this time, a fluid such as vapor or a liquidis discharged from, for example, the heated portion of the living tissueL_(T).

Here, the first fluid discharge groove 332 of the main body 272 of thefirst holding member 262 is arranged outside the continuous electrode302, and the second fluid discharge grooves 334 are arranged in theouter peripheries of the discrete electrodes 304.

In consequence, the fluid discharged owing to the function of thecontinuous electrode 302 flows into the cutter guide groove 262 a, andalso flows into the first fluid discharge groove 332. Then, the fluid isprevented from being discharged from the grooves by the barrier portion342. Therefore, the fluid discharged from the living tissue L_(T) iskept internally from the barrier portion 342, and is prevented frombeing released from the barrier portion. That is, the barrier portion342 performs the function of a dam which prevents the fluid dischargedfrom the living tissue L_(T) from leaking from the barrier portion 342.

The fluid discharged owing to the function of the discrete electrodes304 flows into the second fluid discharge grooves 334. Then, the fluidis prevented from flowing outwards by the barrier portions 344. Inconsequence, the fluid discharged from the living tissue L_(T) is keptinternally from the barrier portions 344, and is prevented from beingreleased from the portions. That is, the barrier portions 344 performthe function of a dam which prevents the fluid discharged from theliving tissue L_(T) from leaking from the barrier portions 344.

The fluid which has flowed into the second fluid discharge grooves 334flows into the first fluid discharge groove 332 through thecommunication paths 336. Then, this fluid joins the fluid which hasflowed into the first fluid discharge groove 332 to flow toward the baseportion 274 of the first holding member 262. Then, the fluid flows intothe cutter guide groove 262 a connected to the first fluid dischargegroove 332 in, for example, the base portion 274. The first fluiddischarge groove 332 communicates with the inside of a cylindricalmember 242 of a shaft 224 (not shown).

Then, the fluid is discharged from a surgical treatment instrument 12via a fluid discharge port 244 a of a sheath 244 through a fluiddischarge port 242 a of the cylindrical member 242 of the shaft 224.

As described above, according to this modification, the following effectis obtained. The description of an effect similar to that described inthe fourth modification of the second embodiment is omitted.

When a high-frequency current is applied to the living tissue L_(T) asthe treatment target held by a holding section 226 of the surgicaltreatment instrument 212, the barrier portions 342, 344, 362 and 364 arebrought into close contact with the living tissue. In consequence, evenwhen the fluid discharged from the living tissue L_(T) as the treatmenttarget flows toward the barrier portions 342, 344 of the first holdingmember 262, the fluid can be introduced into the first and second fluiddischarge grooves 332, 334, 352 and 354 and the communication paths 336,356 of the first and second high-frequency electrodes 266, 270.

In consequence, another peripheral tissue can be prevented from beinginfluenced by the fluid discharged from the portions treated by thehigh-frequency energy and heat energy during the treatment of the livingtissue L_(T). That is, a position to be influenced during the treatmentof the living tissue L_(T) can be limited to the living tissue L_(T) inwhich the high-frequency current is supplied between the firsthigh-frequency electrode 266 and the second high-frequency electrode270.

Therefore, according to this modification, a fluid such as the vapor orliquid (a high-temperature body fluid) generated from the living tissueL_(T) is discharged from the surgical treatment instrument 212 on theside of, for example, the proximal end of the shaft 224 or a handle 222,whereby a living tissue around the living tissue L_(T) as the treatmenttarget can be inhibited from being influenced by a fluid such as thevapor or liquid (the body fluid).

Thus, when the thermal influence on the living tissue L_(T) issuppressed, it is important to guide a fluid such as the vapor or liquidto a position which does not come in contact with the tissue. In a casewhere a tissue which is larger than the holding section 226 to such anextent that the periphery of the holding section 226 is covered issubjected to the treatment, it can be prevented that the outside of theholding section 226 is thermally influenced. In a case where even asmall open portion (space) from which a fluid such as the vapor orliquid leaks is formed in the holding section 226, the fluid isdischarged from the portion, and thermally influences the living tissueL_(T) around the holding section 226.

Moreover, even when the peripheries of the high-frequency electrodes(energy release portions) 266, 270 are covered with the barrier portions342, 344, 362 and 364 to eliminate such an open portion, an open portionmight be formed owing to a fluid pressure such as the vapor pressuregenerated from the living tissue L_(T), and the fluid might bedischarged. Therefore, it is useful means to provide channels (the firstand second fluid discharge grooves 332, 334, 352 and 354 and thecommunication paths 336, 356) which suppress the discharge of theunnecessary fluid due to the rise of the fluid pressure and which guideand discharge the fluid in a predetermined direction.

Next, a modification of the communication paths 336 shown in FIGS. 22Aand 22B will be described with reference to FIG. 22C.

As shown in FIG. 22C, a communication path 336 (hereinafter referred toas a first communication path) is formed as a conduit in the same manneras in the fifth modification. The first communication path 336 isprovided with a tubular second communication path 338 also connected toa cutter guide groove 262 a of a main body 272.

Thus, a fluid generated from a living tissue L_(T) is passed through thefirst and second tubular communication paths 336, 338, whereby, forexample, a fluid which might have a high temperature can be prevented asmuch as possible from being brought into contact with the living tissueL_(T).

Third Embodiment

Next, a third embodiment will be described with reference to FIGS. 23 to24C. This embodiment is a modification of the first and secondembodiments including various modifications.

Here, as one example of an energy treatment instrument, a circular typebipolar energy treatment instrument (a treatment instrument) 412 forperforming a treatment, for example, through or outside an abdominalwall will be described.

As shown in FIG. 23, a treatment system 410 includes the energytreatment instrument 412, an energy source 214 and a foot switch 216.The surgical treatment instrument 412 includes a handle 422, a shaft 424and an openable/closable holding section 426. The handle 422 isconnected to the energy source 214 via a cable 228.

The handle 422 is provided with a holding section opening/closing knob432 and a cutter driving lever 434. The holding section opening/closingknob 432 is rotatable with respect to the handle 422. When the holdingsection opening/closing knob 432 is rotated, for example, clockwise withrespect to the handle 422, a detachable side holding section (adetachable side grasping section) 444 of the holding section 426described later comes away from a main body side holding section (a mainbody side grasping section) 442 (see FIG. 24A). When the knob 432 isrotated counterclockwise, the detachable side holding section 444 comesclose to the main body side holding section 442 (see FIG. 24B).

The shaft 424 is formed into a cylindrical shape. The shaft 424 isappropriately curved in consideration of an insertion property into aliving tissue L_(T). Needless to say, it is also preferable that theshaft 424 is formed to be straight.

The distal end of the shaft 424 is provided with the holding section426. As shown in FIGS. 24A and 24B, the holding section 426 includes themain body side holding section (a first holding member, a first jaw) 442formed on the distal end of the shaft 424, and the detachable sideholding section (a second holding member, a second jaw) 444 detachablyattached to the main body side holding section 442. In a state in whichthe detachable side holding section 444 closes with respect to the mainbody side holding section 442, holding faces 442 a, 444 a of the mainbody side holding section 442 and the detachable side holding section444 come in contact with each other.

The main body side holding section 442 includes a cylindrical member452, a frame 454 and a pipe 456 for energization. These cylindricalmember 452 and frame 454 have an insulation property. The cylindricalmember 452 is connected to the distal end of the shaft 424. The frame454 is arranged so that the frame is fixed to the cylindrical member452.

The central axis of the frame 454 is opened. This opened central axis ofthe frame 454 is provided with the pipe 456 for energization so that thepipe 456 is movable in a predetermined range along the central axis ofthe frame 454. When the holding section opening/closing knob 432 isrotated, this pipe 456 for energization is movable in the predeterminedrange owing to, for example, the function of a ball screw (not shown) asshown in FIGS. 24A and 24B. This pipe 456 for energization is providedwith a protrusion 456 a protruding inwardly in a diametric direction sothat the protrusion 456 a can disengageably be engaged with a connectingportion 482 a of an energization shaft 482 of the detachable sideholding section 444 described later.

As shown in FIGS. 24A and 24B, a cutter guide groove (a space) 466 isformed between the cylindrical member 452 and the frame 454. Acylindrical cutter 462 is arranged in this cutter guide groove 466. Theproximal end of the cutter 462 is connected to the distal end of apusher 464 for the cutter 462 provided on the inner side of the shaft424. The cutter 462 is fixed to the outer peripheral surface of thepusher 464 for the cutter 462. Although not shown, the proximal end ofthe pusher 464 for the cutter 462 is connected to the cutter drivinglever 434 of the handle 422. Therefore, when the cutter driving lever434 of the handle 422 is operated, the cutter 462 moves via the pusher464 for the cutter 462.

A first fluid passage (a fluid passage) 468 a is formed between thepusher 464 for the cutter 462 and the frame 454. Then, the shaft 424 orthe handle 422 is provided with a fluid discharge port (not shown)through which the fluid passed through the first fluid passage 468 a isdischarged.

As shown in FIGS. 24A to 24C, the distal end of the cylindrical member452 is provided with a first high-frequency electrode 472 and a heatermember 474 as an output member and an energy release section.

The first high-frequency electrode 472 is arranged outside the cutterguide groove 466 in which the cutter 462 is arranged. The firsthigh-frequency electrode 472 is formed into an annular shape in the samemanner as in the cutter guide groove 466. The first high-frequencyelectrode 472 is fixed to the distal end of a first energization line472 a. The first energization line 472 a is connected to the cable 228via the main body side holding section 442, the shaft 424 and the handle422.

As shown in FIGS. 24A to 24C, the heater members 474 are fixed to theback surface of the first high-frequency electrode 472 at appropriateintervals. The heater member 474 is fixed to the distal end of anenergization line 474 a for the heater. The energization line 474 a forthe heater is connected to the cable 228 via the main body side holdingsection 442, the shaft 424 and the handle 422.

An annular vapor discharge groove 476 is formed outside the firsthigh-frequency electrode 472. The vapor discharge groove 476 isconnected to the first fluid passage 468 a. Outside the vapor dischargegroove 476, the holding face (a tissue contact face) 442 a is formed ata position higher than the front surface of the first high-frequencyelectrode 472. That is, the holding face 442 a of the main body sideholding section 442 is disposed closer to a head section 484 of thedetachable side holding section 444 described later than the frontsurface of the first high-frequency electrode 472 is. Therefore, theholding face 442 a performs the function of a barrier portion (a dam)which prevents a fluid such as vapor from being discharged from thevapor discharge groove 476.

On the other hand, the detachable side holding section 444 includes theshaft 482 for energization having the connecting portion 482 a and thehead section 484. The shaft 482 for energization has a circular section,and has one end tapered and the other end fixed to the head section 484.The connecting portion 482 a is formed into a concave-groove-like shapewhich is engageable with the protrusion 456 a of the pipe 456 forenergization. The outer surface of the energization shaft 482 other thanthe connecting portion 482 a is insulated by coating or the like.

The head section 484 is provided with a second high-frequency electrode486 so that the electrode 486 faces the first high-frequency electrode472 of the main body side holding section 442. The second high-frequencyelectrode 486 is fixed to one end of a second energization line 486 a.The other end of the second energization line 486 a is electricallyconnected to the shaft 482 for energization.

On the inner side of the second high-frequency electrode 486 provided onthe head section 484, an annular cutter receiving portion 488 is formedto receive the blade of the cutter 462. On the other hand, an annularfluid discharge groove 490 is formed outside the second high-frequencyelectrode 486. Outside the fluid discharge groove 490, the holding face(a tissue contact face) 444 a is formed at a position higher than thefront surface of the second high-frequency electrode 486. That is, theholding face 444 a of the detachable side holding section 444 isdisposed closer to the main body side holding section 442 than the frontsurface of the second high-frequency electrode 486 is. Therefore, theholding face 444 a performs a barrier portion (a dam) which prevents afluid such as the vapor from being discharged from the fluid dischargegroove 490.

Furthermore, the fluid discharge groove 490 is connected to a fluiddischarge path 490 a of the head section 484 and the shaft 482 forenergization. The fluid discharge path 490 a communicates with a secondfluid passage (a fluid passage) 468 b of the pipe 456 for energization.The shaft 204 or the handle 202 is provided with a fluid discharge port(not shown) from which the fluid passed through the second fluid passage468 b is discharged.

It is to be noted that the pipe 456 for energization is connected to thecable 228 via the shaft 424 and the handle 422. In consequence, when theconnecting portion 482 a of the energization shaft 482 of the detachableside holding section 444 is engaged with the protrusion 456 a of thepipe 456 for energization, the second high-frequency electrode 486 iselectrically connected to the pipe 456 for energization.

Next, the function of the treatment system 410 according to thisembodiment will be described.

An operator operates a display section 296 (see FIG. 13) of the energysource 214 in advance to set the output conditions of the treatmentsystem 210. Specifically, a set power Pset [W] of high-frequency energyoutput, a set temperature Tset [° C.] of heat energy output, thresholdvalues Z1, Z2 of an impedance Z of the living tissue L_(T) and the likeare set.

As shown in FIG. 24B, the holding section 426 and the shaft 424 of thesurgical treatment instrument 412 are inserted into an abdominal cavitythrough, for example, an abdominal wall in a state in which the mainbody side holding section 442 is closed with respect to the detachableside holding section 444. The main body side holding section 442 and thedetachable side holding section 444 of the surgical treatment instrument412 are opposed to the living tissue L_(T) to be treated.

To grasp the living tissue L_(T) to be treated between the main bodyside holding section 442 and the detachable side holding section 444,the holding section opening/closing knob 432 of the handle 422 isoperated. At this time, the knob 432 is rotated, for example, clockwisewith respect to the handle 422. Then, as shown in FIG. 24A, the pipe 456for energization is moved to the distal end with respect to the frame454 of the shaft 424. Therefore, the main body side holding section 442and the detachable side holding section 444 open, whereby the detachableside holding section 444 can come away from the main body side holdingsection 442.

Then, the living tissue L_(T) to be treated is arranged between thefirst high-frequency electrode 472 of the main body side holding section442 and the second high-frequency electrode 486 of the detachable sideholding section 444. The energization shaft 482 of the detachable sideholding section 444 is inserted into the energization pipe 456 of themain body side holding section 442. In this state, the grasping sectionopening/closing knob 432 of the handle 422 is rotated, for example,counterclockwise. In consequence, the detachable side holding section444 closes with respect to the main body side holding section 442. Thus,the living tissue L_(T) as the treatment target is held between the mainbody side holding section 442 and the detachable side holding section444.

In this state, the pedal 216 a of the foot switch 216 is operated, andthe energy is supplied from the energy source 214 to the firsthigh-frequency electrode 472 and the second high-frequency electrode 486via the cable 228. Therefore, the living tissue L_(T) between the mainbody side holding section 442 and the detachable side holding section444 is heated by Joule heat. At this time, the impedance Z of thegrasped living tissue L_(T) is measured by a high-frequency energyoutput circuit 292. The impedance Z at the time of treatment start is,for example, about 60[Ω] as shown in FIG. 15. Subsequently, when thehigh-frequency current flows through the living tissue L_(T) and theliving tissue L_(T) is cauterized, the value of the impedance Z oncelowers and then rises.

Thus, when the living tissue L_(T) is cauterized, the fluid (a liquid(blood) and/or a gas (water vapor)) is discharged from the living tissueL_(T). At this time, the fluid discharged from the living tissue L_(T)is allowed to flow into the cutter guide groove 466 and the vapordischarge groove 476 of the main body side holding section 442 and toflow into the fluid discharge groove 490 of the detachable side holdingsection 444. Then, the fluid which has flowed into the cutter guidegroove 466 and the vapor discharge groove 476 of the main body sideholding section 442 is, for example, sucked and discharged from thecutter guide groove 466 to the shaft 424 through the first fluid passage468 a. The fluid allowed to flow into the fluid discharge groove 490 ofthe detachable side holding section 444 is, for example, sucked anddischarged from the fluid discharge path 490 a of the head section 484and energization shaft 482 to the shaft 424 through the second fluidpassage 468 b of the energization pipe 456.

Then, while the fluid is discharged from the living tissue L_(T), thefluid continues to flow into the groove. Therefore, the occurrence ofthermal spread is prevented by the fluid discharged at a raisedtemperature from the living tissue L_(T), and the influence on a portionwhich is not the treatment target can be prevented.

Subsequently, a control section 290 judges whether the impedance Zduring the high-frequency energy output calculated based on a signalfrom the high-frequency energy output circuit 292 is the presetthreshold value Z1 (here, about 1000[Ω] as shown in FIG. 15) or more.The threshold value Z1 is disposed in a position where the rise ratio ofthe beforehand known value of the impedance Z lowers. Then, in a casewhere it is judged that the impedance Z is smaller than the thresholdvalue Z1, the high-frequency energy for the treatment is continuouslyapplied to the living tissue L_(T) grasped between the electrodes 472and 486 of the main body side holding section 442 and the detachableside holding section 444.

In a case where it is judged that the impedance Z is larger than thethreshold value Z1, the control section 290 transmits a signal to a heatgeneration element driving circuit 294. Then, the heat generationelement driving circuit 294 supplies a power to the heater member 474 sothat the temperature of the heater member 474 is a preset temperatureTset [° C.], for example, a temperature of 100 [° C.] to 300 [° C.]. Inconsequence, the living tissue L_(T) grasped between the electrodes 472and 486 of the main body side holding section 442 and the detachableside holding section 444 conducts heat to the first high-frequencyelectrode 472 owing to heat conduction from the heater member 474, andthe heat coagulates the living tissue L_(T) internally from the side ofthe front surface of the living tissue L_(T) which comes in closecontact with the first high-frequency electrode 472.

Subsequently, the control section 290 judges whether the impedance Z ofthe living tissue L_(T) monitored by the high-frequency energy outputcircuit 292 is a preset threshold value Z2 or more. In a case where itis judged that the impedance Z is smaller than the threshold value Z2,the energy continues to be applied to the heater member 474. On theother hand, in a case where it is judged that the impedance Z is thethreshold value Z2 or more, the control section 290 issues a buzzersound from a speaker 298, and stops the output of high-frequency energyand heat energy. In consequence, the treatment of the living tissueL_(T) by use of the treatment system 410 is completed.

In this case, the living tissue L_(T) is continuously (in asubstantially annular state) denatured by the first and secondhigh-frequency electrodes 472, 486.

Subsequently, when the cutter driving lever 434 of the handle 422 isoperated, the cutter 462 protrudes from the cutter guide groove 466 ofthe main body side holding section 442, and moves toward the cutterreceiving portion 488 of the detachable side holding section 444. Thedistal end of the cutter 462 has a blade, so that the treated livingtissue L_(T) is cut into a circular shape or the like.

As described above, according to this embodiment, the following effectis obtained.

The first high-frequency electrode 472 and the heater member 474 arearranged on the main body side holding section 442, and the secondhigh-frequency electrode 486 is arranged on the detachable side holdingsection 444. In consequence, the living tissue L_(T) between the mainbody side holding section 442 and the detachable side holding section444 can be heated, denatured and bonded by the high-frequency energy andthe heat energy. Therefore, the living tissues L_(T) are sealed into asubstantially annular shape.

Moreover, in this embodiment, the bipolar surgical treatment instrument412 has been described, but it is also preferable to use a monopolarhigh-frequency treatment as described in the first embodiment withreference to FIG. 3B.

First Modification of Third Embodiment

Next, a first modification will be described with reference to FIG. 25.

On a main body side holding section 442 of a surgical treatmentinstrument 412 shown in FIG. 25, unlike the first high-frequencyelectrode 472 of the third embodiment, a plurality of discreteelectrodes 472 a for outputting high-frequency energy are arranged. Thediscrete electrodes 472 a are arranged at predetermined intervals alonga circumference. Although not shown, a heater member 474 is arranged onthe back surfaces of the plurality of discrete electrodes 472 a.

In each discrete electrode 472 a, instead of a vapor discharge groove476, a fluid discharge hole 476 a is formed in the center of thediscrete electrode 472 a. Furthermore, barrier portions 442 b having thesame plane as holding faces 442 a are arranged in the outer peripheriesof the respective discrete electrodes 472 a.

Therefore, the fluid discharged from the living tissue L_(T) owing tothe function (including the function of the heater member 474) of therespective discrete electrodes 472 a is prevented from being releasedoutwards by the barrier portions 442 b. Then, the fluid discharged fromthe living tissue L_(T) flows into the fluid discharge holes 476 adisposed in the centers of the discrete electrodes 472 a. In this case,the fluid which has flowed into the fluid discharge holes 476 a is, forexample, sucked and discharged from a cutter guide groove 466 to a shaft424 through a first fluid passage 468 a.

On the other hand, a second high-frequency electrode of a detachableside holding section 444 is not shown, but as described in the thirdembodiment, a continuous electrode formed into an annular shape may bearranged, or the second high-frequency electrode may be arrangedsimilarly to (symmetrically with respect to) the discrete electrodes 472a of the main body side holding section 442 according to thismodification.

It is to be noted that in the third embodiment including thismodification, the use of the high-frequency electrodes 472, 472 a shownin FIGS. 24C and 25 has been described, but the shapes and arrangementof the electrodes can variously be modified as in, for example, theconfiguration described in the second embodiment including variousmodifications. In consequence, for example, it is also preferable toarrange discrete electrodes or branched electrodes outside thehigh-frequency electrode 472 shown in FIG. 24C.

Additional advantages and modifications will readily occur to thoseskilled in the art. Therefore, the invention in its broader aspects isnot limited to the specific details and representative embodiments shownand described herein. Accordingly, various modifications may be madewithout departing from the spirit or scope of the general inventiveconcept as defined by the appended claims and their equivalents.

What is claimed is:
 1. A surgical controller for controlling anelectrosurgical apparatus, the surgical controller comprising: a circuitconfigured to detect an impedance of a tissue between a pair of holdingmembers disposed at the electrosurgical apparatus and to output animpedance value indicative of the impedance; and one or more processorsconfigured to implement: controlling a first generator to apply a firstelectric power to a first energy element that is provided on each of theholding members and is configured to apply a first energy to the tissue,the first energy generating Joule heat in the tissue to heat the tissue;receiving the impedance value from the circuit; when the impedance valuereaches a first threshold value, controlling a second generator to set asecond electric power to be applied to a second energy element to avalue higher than before reaching the first threshold value, the secondenergy element being configured to apply a second energy to the tissue,the second energy coagulating the tissue from a surface side of thetissue contacting a grasping face of the holding members towards aninside of the tissue; and when the impedance value reaches the secondthreshold value, controlling the second generator to stop applying thesecond electric power.
 2. The surgical controller according to claim 1,wherein the one or more processors is configured to implementcontrolling the second generator to apply the second electric power tothe second energy element from before when the impedance value reachesthe first threshold value.
 3. The surgical controller according to claim2, wherein the one or more processors is configured to implementcontrolling the second generator to gradually increase a value of thesecond electric power when the impedance value reaches the firstthreshold value, and maintain a certain value thereafter.
 4. Thesurgical controller according to claim 2, wherein the one or moreprocessors is configured to implement controlling the second generatorto apply the second electric power to the second energy elementdiscontinuously before when the impedance value reaches the firstthreshold value.
 5. The surgical controller according to claim 2,wherein the one or more processors is configured to implementcontrolling the second generator to keep the tissue at temperature T0that would not cause protein denaturation during until when theimpedance value reaches the first threshold value.
 6. The surgicalcontroller according to claim 1, wherein the one or more processors isconfigured to implement controlling the second generator not to applythe second electric power to the second energy element until when theimpedance value reaches the first threshold value.
 7. A surgical systemcomprising: an electrosurgical apparatus including: a pair of holdingmembers that is configured to grasp a tissue; a first energy elementthat is provided on each of the holding members, and is configured toapply a first energy to the tissue, the first energy generating Jouleheat in the tissue to heat the tissue; and a second energy element thatis provided on at least one of the holding members, and is configured toapply a second energy to the tissue, the second energy coagulating thetissue from a surface side of the tissue contacting a grasping face ofthe electrodes towards an inside of the tissue; and a controllerconfigure to control output of the first energy and output of the secondenergy, wherein the controller is configured to implement: controllingthe first energy element to output the first energy, measuring impedanceof the tissue grasped by the pair of holding members and outputting animpedance value indicative of the impedance, when the impedance valuereaches a first threshold value, controlling the second energy elementto output the second energy at an output that is higher than that beforereaching the first threshold value, and when the impedance value reachesa second threshold value that is higher than the first threshold value,controlling the second energy element to stop the output of the secondenergy.
 8. The surgical system according to claim 7, wherein the firstenergy element is a high-frequency electrode that is configured to applythe first energy as a high-frequency current to the tissue, and thesecond energy element is a heater that is configured to apply heat tothe tissue.
 9. The surgical system according to claim 7, wherein thecontroller is configured to implement controlling the second energyelement to apply the second energy to the tissue from before when theimpedance value reaches the first threshold value.
 10. The surgicalsystem according to claim 9, wherein the controller is configured toimplement controlling the second energy element to gradually increase avalue of the second energy when the impedance value reaches the firstthreshold value, and maintain a certain value thereafter.
 11. Thesurgical system according to claim 9, wherein the controller isconfigured to implement controlling the second energy element to applythe second energy discontinuously to the tissue before when theimpedance value reaches the first threshold value.
 12. The surgicalsystem according to claim 9, wherein the controller is configured toimplement controlling the second energy element to keep the tissue attemperature T0 that would not cause protein denaturation during untilwhen the impedance value reaches the first threshold value.
 13. Thesurgical system according to claim 7, wherein the controller isconfigured to implement controlling the second energy element not toapply the second energy to the tissue until when the impedance valuereaches the first threshold value.
 14. A method for controlling anelectrosurgical apparatus, the method comprising: controlling a firstenergy element that is provided on a pair of holding members that isconfigured to grasp a tissue, and is configured to apply a first energyto the tissue, the first energy generating Joule heat in the tissue toheat the tissue; measuring impedance of the tissue grasped by the pairof holding members and outputting an impedance value indicative of theimpedance; controlling a second energy element that is provided on atleast one of the pair of holding members, and is configured to apply asecond energy to the tissue, the second energy coagulating the tissuefrom a surface side of the tissue contacting a grasping face of the atleast one of the pair of holding members towards an inside of thetissue, and when the impedance value reaches a first threshold value,outputting the second energy at an output that is higher than thatbefore reaching the first threshold value; and when the impedance valuereaches a second threshold value that is higher than the first thresholdvalue, controlling the second energy element to stop the output of thesecond energy.
 15. The method according to claim 14, comprisingcontrolling the second energy element to apply the second energy to thetissue from before when the impedance value reaches the first thresholdvalue.
 16. The method according to claim 15, comprising controlling thesecond energy element to gradually increase a value of the second energywhen the impedance value reaches the first threshold value, and maintaina certain value thereafter.
 17. The method according to claim 15,comprising controlling the second energy element to apply the secondenergy discontinuously to the tissue before when the impedance valuereaches the first threshold value.
 18. The method according to claim 15,comprising controlling the second energy element to keep the tissue attemperature T0 that would not cause protein denaturation during untilwhen the impedance value reaches the first threshold value.
 19. Themethod according to claim 14, comprising controlling the second energyelement not to apply the second energy to the tissue until when theimpedance value reaches the first threshold value.